‘We know little about the effect of diet on health. That’s why so much is written about it’. That is the title of a post in which I advocate the view put by John Ioannidis that remarkably little is known about the health effects if individual nutrients. That ignorance has given rise to a vast industry selling advice that has little evidence to support it.
The 2016 Conference of the so-called "College of Medicine" had the title "Food, the Forgotten Medicine". This post gives some background information about some of the speakers at this event. I’m sorry it appears to be too ad hominem, but the only way to judge the meeting is via the track record of the speakers.
Quite a lot has been written here about the "College of Medicine". It is the direct successor of the Prince of Wales’ late, unlamented, Foundation for Integrated Health. But unlike the latter, its name is disguises its promotion of quackery. Originally it was going to be called the “College of Integrated Health”, but that wasn’t sufficently deceptive so the name was dropped.
For the history of the organisation, see
The new “College of Medicine” arising from the ashes of the Prince’s Foundation for Integrated Health
Don’t be deceived. The new “College of Medicine” is a fraud and delusion
The College of Medicine is in the pocket of
Crapita Capita. Is Graeme Catto selling out?
The conference programme (download pdf) is a masterpiece of bait and switch. It is a mixture of very respectable people, and outright quacks. The former are invited to give legitimacy to the latter. The names may not be familiar to those who don’t follow the antics of the magic medicine community, so here is a bit of information about some of them.
The introduction to the meeting was by Michael Dixon and Catherine Zollman, both veterans of the Prince of Wales Foundation, and both devoted enthusiasts for magic medicne. Zollman even believes in the battiest of all forms of magic medicine, homeopathy (download pdf), for which she totally misrepresents the evidence. Zollman works now at the Penny Brohn centre in Bristol. She’s also linked to the "Portland Centre for integrative medicine" which is run by Elizabeth Thompson, another advocate of homeopathy. It came into being after NHS Bristol shut down the Bristol Homeopathic Hospital, on the very good grounds that it doesn’t work.
Now, like most magic medicine it is privatised. The Penny Brohn shop will sell you a wide range of expensive and useless "supplements". For example, Biocare Antioxidant capsules at £37 for 90. Biocare make several unjustified claims for their benefits. Among other unnecessary ingredients, they contain a very small amount of green tea. That’s a favourite of "health food addicts", and it was the subject of a recent paper that contains one of the daftest statistical solecisms I’ve ever encountered
"To protect against type II errors, no corrections were applied for multiple comparisons".
If you don’t understand that, try this paper.
The results are almost certainly false positives, despite the fact that it appeared in Lancet Neurology. It’s yet another example of broken peer review.
It’s been know for decades now that “antioxidant” is no more than a marketing term, There is no evidence of benefit and large doses can be harmful. This obviously doesn’t worry the College of Medicine.
Margaret Rayman was the next speaker. She’s a real nutritionist. Mixing the real with the crackpots is a standard bait and switch tactic.
Eleni Tsiompanou, came next. She runs yet another private "wellness" clinic, which makes all the usual exaggerated claims. She seems to have an obsession with Hippocrates (hint: medicine has moved on since then). Dr Eleni’s Joy Biscuits may or may not taste good, but their health-giving properties are make-believe.
Andrew Weil, from the University of Arizona
gave the keynote address. He’s described as "one of the world’s leading authorities on Nutrition and Health". That description alone is sufficient to show the fantasy land in which the College of Medicine exists. He’s a typical supplement salesman, presumably very rich. There is no excuse for not knowing about him. It was 1988 when Arnold Relman (who was editor of the New England Journal of Medicine) wrote A Trip to Stonesville: Some Notes on Andrew Weil, M.D..
“Like so many of the other gurus of alternative medicine, Weil is not bothered by logical contradictions in his argument, or encumbered by a need to search for objective evidence.”
This blog has mentioned his more recent activities, many times.
Alex Richardson, of Oxford Food and Behaviour Research (a charity, not part of the university) is an enthusiast for omega-3, a favourite of the supplement industry, She has published several papers that show little evidence of effectiveness. That looks entirely honest. On the other hand, their News section contains many links to the notorious supplement industry lobby site, Nutraingredients, one of the least reliable sources of information on the web (I get their newsletter, a constant source of hilarity and raised eyebrows). I find this worrying for someone who claims to be evidence-based. I’m told that her charity is funded largely by the supplement industry (though I can’t find any mention of that on the web site).
Stephen Devries was a new name to me. You can infer what he’s like from the fact that he has been endorsed byt Andrew Weil, and that his address is "Institute for Integrative Cardiology" ("Integrative" is the latest euphemism for quackery). Never trust any talk with a title that contains "The truth about". His was called "The scientific truth about fats and sugars," In a video, he claims that diet has been shown to reduce heart disease by 70%. which gives you a good idea of his ability to assess evidence. But the claim doubtless helps to sell his books.
Prof Tim Spector, of Kings College London, was next. As far as I know he’s a perfectly respectable scientist, albeit one with books to sell, But his talk is now online, and it was a bit like a born-again microbiome enthusiast. He seemed to be too impressed by the PREDIMED study, despite it’s statistical unsoundness, which was pointed out by Ioannidis. Little evidence was presented, though at least he was more sensible than the audience about the uselessness of multivitamin tablets.
Simon Mills talked on “Herbs and spices. Using Mother Nature’s pharmacy to maintain health and cure illness”. He’s a herbalist who has featured here many times. I can recommend especially his video about Hot and Cold herbs as a superb example of fantasy science.
Annie Anderson, is Professor of Public Health Nutrition and
Founder of the Scottish Cancer Prevention Network. She’s a respectable nutritionist and public health person, albeit with their customary disregard of problems of causality.
Patrick Holden is chair of the Sustainable Food Trust. He promotes "organic farming". Much though I dislike the cruelty of factory farms, the "organic" industry is largely a way of making food more expensive with no health benefits.
The Michael Pittilo 2016 Student Essay Prize was awarded after lunch. Pittilo has featured frequently on this blog as a result of his execrable promotion of quackery -see, in particular, A very bad report: gamma minus for the vice-chancellor.
Nutritional advice for patients with cancer. This discussion involved three people.
Professor Robert Thomas, Consultant Oncologist, Addenbrookes and Bedford Hospitals, Dr Clare Shaw, Consultant Dietitian, Royal Marsden Hospital and Dr Catherine Zollman, GP and Clinical Lead, Penny Brohn UK.
Robert Thomas came to my attention when I noticed that he, as a regular cancer consultant had spoken at a meeting of the quack charity, “YestoLife”. When I saw he was scheduled tp speak at another quack conference. After I’d written to him to point out the track records of some of the people at the meeting, he withdrew from one of them. See The exploitation of cancer patients is wicked. Carrot juice for lunch, then die destitute. The influence seems to have been temporary though. He continues to lend respectability to many dodgy meetings. He edits the Cancernet web site. This site lends credence to bizarre treatments like homeopathy and crystal healing. It used to sell hair mineral analysis, a well-known phony diagnostic method the main purpose of which is to sell you expensive “supplements”. They still sell the “Cancer Risk Nutritional Profile”. for £295.00, despite the fact that it provides no proven benefits.
Robert Thomas designed a food "supplement", Pomi-T: capsules that contain Pomegranate, Green tea, Broccoli and Curcumin. Oddly, he seems still to subscribe to the antioxidant myth. Even the supplement industry admits that that’s a lost cause, but that doesn’t stop its use in marketing. The one randomised trial of these pills for prostate cancer was inconclusive. Prostate Cancer UK says "We would not encourage any man with prostate cancer to start taking Pomi-T food supplements on the basis of this research". Nevertheless it’s promoted on Cancernet.co.uk and widely sold. The Pomi-T site boasts about the (inconclusive) trial, but says "Pomi-T® is not a medicinal product".
There was a cookery demonstration by Dale Pinnock "The medicinal chef" The programme does not tell us whether he made is signature dish "the Famous Flu Fighting Soup". Needless to say, there isn’t the slightest reason to believe that his soup has the slightest effect on flu.
In summary, the whole meeting was devoted to exaggerating vastly the effect of particular foods. It also acted as advertising for people with something to sell. Much of it was outright quackery, with a leavening of more respectable people, a standard part of the bait-and-switch methods used by all quacks in their attempts to make themselves sound respectable. I find it impossible to tell how much the participants actually believe what they say, and how much it’s a simple commercial drive.
The thing that really worries me is why someone like Phil Hammond supports this sort of thing by chairing their meetings (as he did for the "College of Medicine’s" direct predecessor, the Prince’s Foundation for Integrated Health. His defence of the NHS has made him something of a hero to me. He assured me that he’d asked people to stick to evidence. In that he clearly failed. I guess they must pay well.
This post was written for the Spectator Health section, at short notice after the release of the spider letters. The following version is almost the same as appeared there, with a few updates. Some of the later sections are self-plagiarised from earlier posts.
The age of enlightenment was a beautiful thing. People cast aside dogma and authority. They started to think for themselves. Natural science flourished. Understanding of the natural world increased. The hegemony of religion slowly declined. Eventually real universities were created and real democracy developed. The modern world was born.
People like Francis Bacon, Voltaire and Isaac Newton changed the world for the better. Well, that’s what most people think. But not Charles, Prince of Wales and Duke of Cornwall.
In 2010 he said
"I was accused once of being the enemy of the Enlightenment,” he told a conference at St James’s Palace. “I felt proud of that.” “I thought, ‘Hang on a moment’. The Enlightenment started over 200 years ago. It might be time to think again and review it and question whether it is really effective in today’s conditions."
It seems that the Prince preferred things as they were before 1650. That’s a remarkable point of view for someone who, if he succeeds, will become the patron of that product of the age of enlightenment, the Royal Society, a venture that got its Royal Charter from King Charles II in1622.
I suppose that the Prince cannot be blamed for his poor education. He may have been at Trinity College Cambridge, his 2.2 degree is the current euphemism for a fail (it seems that he even failed to learn the dates of the enlightenment).
His behaviour has brought to the fore the question of the role of the monarchy.
A constitutional monarch is purely ceremonial and plays no part in politics. Well actually in the UK it isn’t quite as simple as that. The first problem is that we have no constitution. Things haven’t changed much since the 19th century when Walter Bagehot said “the Sovereign has, under a constitutional monarchy… three rights—the right to be consulted, the right to encourage, the right to warn.”.
These are real powers in a country which is meant to be run by elected representatives. But nobody knows how these powers are used: it is all done in secret. Well, almost all. The Prince of Wales has been unusually public in expressing his views. His views bear directly on government policy in many areas: medicine, architecture, agriculture and the environment. These are mostly areas that involve at least an elementary knowledge of science. But that is something that he lacks. Worse still, he seems to have no consciousness of his ignorance.
The Royal family should clearly have no influence whatsoever on government policies in a democracy. And they should be seen to have no influence. The Queen is often praised for her neutrality, but the fact is that nobody has the slightest idea what happens at the weekly meetings between the Prime Minister and the Queen. I doubt that she advises the prime minister to create a National Health Service, or to tax the rich. We shall never know that. We should do.
Almost the only light that has been thrown on the secret activities of Charles was the release, on 13 May, of 27 letters that the Prince wrote to government ministers in the Blair government between 2004 and 2005. It has take 10 years of effort by the Guardian to get hold of the letters. It was ike getting blood from a stone. When the Information Commissioner ruled that the letters should be made public, the decision was vetoed by the Conservative attorney general, Dominic Grieve. He said. of the "particularly frank" letters,
" Disclosure of the correspondence could damage The Prince of Wales’ ability to perform his duties when he becomes King."
That, of course, is precisely why the documents should be revealed.
If Charles’ ability to perform his duty as King is damaged, should his subjects be kept unaware of that fact? Of course not.
In this case, the law prevailed over the attorney general. After passing through the hands of 16 different judges, the Supreme Court eventually ruled, in March, that the government’s attempts to block release were unlawful. The government spent over £400,000 in trying, and failing, to conceal what we should know. The Freedom of Information Act (2000) is the best thing that Tony Blair did, though he, and Jack Straw, thought it was the worst. I expect they are afraid of what it might reveal about their own records. Transparency is not favoured by governments of any hue.
What do the letters say?
You can read all the letters on the Guardian web site. They give the impression of being written by a rather cranky old man with bees in his bonnet and too much time on his hands. The problem is that not all cranky old men can write directly to the prime minister, and get an answer.
Not all the letters are wrong headed. But all attempt to change government policy. They represent a direct interference in the political process by the heir to the throne. That is unacceptable in a democracy. It disqualifies him from becoming king.
Some letters verged on the bizarre.
21 October 2004
I particularly hope that the illegal fishing of the Patagonian Toothfish will be high on your list of priorities because until the trade is stopped, there is little hope for the poor old albatross.
No doubt illegal fishing is a problem, but not many people would write directly to a minister about the Patagonian Toothfish.
Others I agree with. But they are still attempts to influence the policies of the elected government. This one was about the fact that supermarkets pay so little to dairy farmers for milk that sometimes it’s cheaper than bottled water.
To Tony Blair 8 September 2004
". . . unless United Kingdom co-operatives can grow sufficiently the processors and retailers will continue to have the farmers in an arm lock and we will continue to shoot ourselves in the foot! You did kindly say that you would look at this . . . ".
He wrote to the minister of education to try to influence education policy.
22 February 2005
"I understand from your predecessor, Charles Clarke, that he has spoken to you about my most recent letter of 24th November, and specifically about the impact of my Education Summer School for teachers of English and History. This Programme, which involves up to ninety state school teachers each year, has been held over the past three years in Dartington, Devon, at Dunston, in Norfolk and at Buxton, in Derbyshire. I believe that they have added fresh inspiration to the national debate about the importance of English Literature and History in schools."
Despite having made substantial progress, as you may be aware I remain convinced that the correct approaches to teaching and learning need to be challenged
It’s interesting that the meeting was in Dartington. That’s near Totnes ("twinned with Narnia") and it’s a centre for the bizarre educational cult promoted by the mystic and racist, Rudolf Steiner.
Then we get a reference to one of Charles’ most bizarre beliefs, alternative medicine.
24 February 2005
Dear Prime Minister,
We briefly mentioned the European Union Directive on Herbal Medicines, which is having such a deleterious effect on complementary medicine sector in this country by effectively outlawing the use of certain herbal extracts. I think we both agreed this was using a sledgehammer to crack a nut. You rightly asked me what could be done about it and I am asking the Chief Executive of my Foundation for Integrated Health to provide a more detailed briefing which I hope to be able to send shortly so that your advisers can look at it. Meanwhile, I have given Martin Hurst a note suggesting someone he could talk to who runs the Herbal Practitioner’s Association.
Yours ever, Charles
In this he opposes the EU Directive on Herbal Medicines. All this directive did was to insist that there was some anecdotal evidence for the safety of things that are sold to you. It asked for no evidence at all that they work, and it allowed very misleading labels. It provided the weakest form of protection from the deluded and charlatans. It was put into effect in the UK by the Medicines and Healthcare Products Regulatory Authority (MHRA). They even allowed products that were registered under this scheme to display an impressive-looking “kite-mark”. Most people would interpret this as a government endorsement of herbal medicines.
This got a sympathetic response from Tony Blair, someone who, along with his wife, was notoriously sympathetic to magic medicine.
30 March 2005
Dear Prince Charles
Thanks too for your contacts on herbal medicines who have been sensible and constructive. They feel that the directive itself is sound and the UK regulators excellent, but are absolutely correct in saying that the implementation as it is currently planned is crazy. We can do quite a lot here: we will delay implementation for all existing products to 2011; we will take more of the implementation upon ourselves; and I think we can sort out the problems in the technical committee – where my European experts have some very good ideas. We will be consulting with your contacts and others on the best way to do this we simply cannot have burdensome regulation here.
Yours ever, Tony
Note "absolutely correct in saying that the implementation as it is currently planned is crazy. We can do quite a lot here: we will delay implementation for all existing products to 2011".
Government support for acupuncture and herbal medicine was made explicit in a letter from Health Secretary, John Reid (February 2005). He assures the prince that government is taking action to "enhance the status of the herbal medicine and acupuncture professions".
Nothing could reveal more clearly the clueless attitude of the then government to quackery. In fact, after 15 years of wrangling, the promised recognition of herbalism by statutory regulation never happened. One is reminded of the time that an equally-clueless minister, Lord (Phillip) Hunt, referred to ‘psychic surgery’ as a “profession”.
We got a preview of the Prince’s letters a month before the release when Max Hastings wrote in the Spectator
I have beside me a copy of a letter allegedly written by him some years ago to a cultural institution, asserting the conviction that ‘there is a DIVINE Source which is ultimate TRUTH… that this Truth can be expressed by means of numbers… and that, if followed correctly, these principles can be expressed with infinite variety to produce Beauty’.
You can’t get much barmier than that.
Are the letters harmless?
That has been the reaction on the BBC. I can’t agree. In one sense they so trivial that it’s amazing that the government thought it was a good use of £400,000 to conceal them. But they are all the evidence that we’ll get of the Prince’s very direct attempts to influence the political process.
The Prince of Wales is more than just a crank. He has done real harm. Here are some examples.
When the generally admirable NHS Choices re-wrote their advice on homeopathy (the medicines that contain no medicine) the new advice took two years to appear. It was held up in the Department of Health while consultations were made with the Prince’s Foundation for Integrated Health. That’s Charles’ lobby organisation for crackpot medicine. (The word "integrated" is the euphemism for alternative medicine that’s in favour with its advocates.) If it were not for the fact that I used the Freedom of Information Act to find out what was going on, the public would have been given bad advice as a direct result of the Prince’s political interference.
The Prince’s Foundation for Integrated Health (FIH) folded in 2010 as a result of a financial scandal, but it was quickly reincarnated as the "College of Medicine". It was originally going to be named the College of Integrated Medicine, but it was soon decided that this sounded too much like quackery, so it was given the deceptive name, College of Medicine. It appears to be financed by well-known outsourcing company Capita. It’s closely connected with Dr Michael Dixon, who was medical advisor to the FIH, and who tried to derail the advice given by NHS Choices.
Perhaps the worst example of interference by the Prince of Wales, was his attempt to get an academic fired. Prof Edzard Ernst is the UK’s foremost expert on alternative medicine. He has examined with meticulous care the evidence for many sorts of alternative medicine.Unfortunately for its advocates, it turned out that there is very little evidence that any of it works. This attention to evidence annoyed the Prince, and a letter was sent from Clarence House to Ernst’s boss, the vice-chancellor of the University of Exeter, Steve Smith. Shamefully, Smith didn’t tell the prince to mind his ow business, but instead subjected Ernst to disciplinary proceedings, After subjecting him to a year of misery, he was let off with a condescending warning letter, but Ernst was forced to retire early. In 2011and the vice-chancellor was rewarded with a knighthood. His university has lost an honest scientist but continues to employ quacks.
Not just interfering but costing taxpayers’ money
The Prince’s influence seems to be big in the Department of Health (DH). He was given £37,000 of taxpayers’ money to produce his Patients’ Guide (I produced a better version for nothing). And he was paid an astonishing £900,000 by DH to prepare the ground for the setting up of the hapless self-regulator, the Complementary and Natural Healthcare Council (CNHC, also known as Ofquack).
The Prince of Wales’ business, Duchy Originals, has been condemned by the Daily Mail, (of all places) for selling unhealthy foods. And when his business branched into selling quack “detox” and herbal nonsense he found himself censured by both the MHRA and the Advertising Standards Authority (ASA) for making unjustifiable medical claims for these products.
It runs in the family
The Prince of Wales is not the only member of the royal family to be obsessed with bizarre forms of medicine. The first homeopath to the British royal family, Frederick Quin, was a son of the Duchess of Devonshire (1765-1824). Queen Mary (1865-1953), wife of King George V, headed the fundraising efforts to move and expand the London Homeopathic Hospital. King George VI was so enthusiastic that in 1948 he conferred the royal title on the London Homeopathic Hospital.
The Queen Mother loved homeopathy too (there is no way to tell whether this contributed to her need for a colostomy in the 1960s).
The present Queen’s homeopathic physician is Peter Fisher, who is medical director of what, until recently was called the Royal London Homeopathic Hospital (RLHH). In 2010 that hospital was rebranded as the Royal London Hospital for Integrated medicine (RLHIM) in another unsubtle bait and switch move.
The RLHIM is a great embarrassment to the otherwise excellent UCLH Trust. It has been repeatedly condemned by the Advertising Standards Authority for making false claims. As a consequence, it has been forced to withdraw all of its patient information.
The patron of the RLHIM is the Queen, not the Prince of Wales. It is hard to imagine that this anachronistic institution would still exist if it were not for the influence, spoken or unspoken, of the Queen. Needless to say we will never be told.
The royal warrant for a firm that sells "meningitis vaccine" that contains nothing
Ainsworth’s homeopathic pharmacy is endorsed by both Prince Charles and the Queen: it has two Royal Warrants, one from each of them. They sell “homeopathic vaccines” for meningitis, measles, rubella and whooping cough. These “vaccines” contain nothing whatsoever so they are obviously a real danger to public health.
Despite the fact that Ainsworth’s had already been censured by the ASA in 2011 for selling similar products, Ainsworth’s continued to recommend them with a “casual disregard for the law”.
The regulator (the MHRA) failed to step in to stop them until it was eventually stirred into action by a young BBC reporter, Sam Smith who made a programme for BBC South West. Then, at last, the somnolent regulator was stirred into action. The MHRA “told Ainsworths to stop advertising a number of products” (but apparently not to stop making them or selling them).
They still sell Polonium metal 30C and Swine Meningitis 36C, and a booklet that recommends homeopathic “vaccination”.
Ainsworth’s sales are no doubt helped by the Royal Warrants. The consequence is that people may die of meningitis. In 2011, the MHRA Chief Executive Professor Kent Woods, was knighted. It was commented, justly, that
"Children will be harmed by this inaction. Children will die. And the fault must lie with Professor Sir Kent Woods, chairman of the regulator "
But the regulator has to fight the political influence of the Queen and Prince Charles. They lost.
The attorney general, while trying to justify the secrecy of Charles’ letters, said
“It is a matter of the highest importance within our constitutional framework that the Monarch is a politically neutral figure”.
Questions about health policy are undoubtedly political, and the highly partisan interventions of the Prince in the political process make his behaviour unconstitutional.
The Prince’s petulant outbursts not only endanger patients. They endanger the monarchy itself. Whether that matters depends on how much you value the tourist business generated by the Gilbert & Sullivan flummery at which royals excel.
The least that one can ask of the royal family is that they should not endanger the health of the nation. It would help if they refrained from using their influence on matters that are beyond their intellectual grasp..
If I wanted to know the winner of the 2.30 at Ascot, I’d ask a royal. For any other question I’d ask someone with more education.
The letters have made headlines in just about every newspaper. The Guardian had extensive coverage, of course.
The Times had a front page story "Revealed: how Charles got Blair to alter health policy" [pdf]
The British Medical Journal wrote "Prince Charles delayed regulation of herbal medicines" [pdf]
For me, the most shocking item was an interview given by Jack Straw, on Radio 4’s Today Programme. He was Home Secretary from 1997 to 2001 and Foreign Secretary from 2001 to 2006 under Tony Blair. From 2007 to 2010 he was Lord Chancellor. His response to the letters sounded like that of a right-wing conservative.
Like Blair. he deplored the Freedom of Information Act that his own government passed. He defended the secrecy, and supported the Conservative attorney-general’s attempt to veto the release of the letters. Perhaps his defence of secrecy is not surprising, He has a lot to hide, His involvement in the mendacity that led to the Iraq war, the dodgy dossier, his role in covering up torture (the "rendition" scandal). And He was suspended by the Labour party in February 2015 due to allegation of cash bribes.
He is certainly a man with plenty of things to hide.
It makes a nice change to be able to compliment an official government report.
Ever since the House of Lords report in 2000, the government has been vacillating about what should be done about herbalists. At the moment both western herbalists and traditional Chinese medicine (TCM) are essentially unregulated. Many (but not all) herbalists have been pushing for statutory regulation, which they see as government endorsement. It would give them a status like the General Medical Council.
A new report has ruled out this possibility, for very good reasons [download local copy].
Back story (abridged!)
My involvement began with the publication in 2008 of a report on the Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine . That led to my post, A very bad report: gamma minus for the vice-chancellor. The report was chaired by the late Professor Michael Pittilo BSc PhD CBiol FIBiol FIBMS FRSH FLS FRSA, Principal and Vice-Chancellor of The Robert Gordon University, Aberdeen. The membership of the group consisted entirely of quacks and the vice -chancellor’s university ran a course in homeopathy (now closed).
The Pittilo report recommended statutory regulation and "The threshold entry route to the register will normally be through a Bachelor degree with Honours". It ignored entirely the little problem that you can’t run a BSc degree in a subject that’s almost entirely devoid of evidence. It said, for example that acupuncturists must understand " yin/yang, 5 elements/phases, eight principles, cyclical rhythms, qi ,blood and body fluids". But of course there is nothing to "understand"! They are all pre-scientific myths. This “training dilemma” was pointed out in one of my earliest posts, You’d think it was obvious, but nonetheless the then Labour government seemed to take this absurd report seriously.
In 2009 a consultation was held on the Pittilo report. I and many of my friends spent a lot of time pointing out the obvious. Eventually the problem was again kicked into the long grass.
The THR scheme
Meanwhile European regulations caused the creation of the Traditional Herbal Registration (THR) scheme. It’s run by the Medicines and Healthcare products Regulatory Authority (MHRA). This makes it legal to put totally misleading claims on labels of herbal concoctions, as long as they are registered with THR, They also get an impressive-looking certification mark. All that’s needed to get THR registration is that the ‘medicines’ are not obviously toxic and they have been in use for 30 years. There is no need to supply any information whatsoever about whether they work or not. This appears to contradict directly the MHRA’s brief:
"”We enhance and safeguard the health of the public by ensuring that medicines and medical devices work and are acceptably safe."
After much effort, I elicited an admission from the MHRA that there was no reason to think that any herbal concoctions were effective, and that there was nothing to prevent them from adding a statement to say so on the label. They just chose not to do so. That’s totally irresponsible in my opinion. See Why does the MHRA refuse to label herbal products honestly? Kent Woods and Richard Woodfield tell me. Over 300 herbal products have been registered under the THR scheme (a small percentage of the number of products being used). So far only one product of Tibetan medicine and one traditional Chinese medicine have been registered under THR. These are the only ones that can be sold legally now, because no herbs whatsoever have achieved full marketing authorisation -that requires good evidence of efficacy and that doesn’t exist for any herb.
The current report
Eventually, in early 2014, the Tory-led government set up yet another body, "Herbal Medicines and Practitioners Working Group " (HMPWG). My heart sank when I saw its membership (Annex A.2). The vice-chair was none other that the notorious David Tredinnick MP (Con, Bosworth). It was stuffed with people who had vested interests. I wrote to the chair and to the few members with scientific credentials to put my views to them.
But my fears were unfounded, because the report of the HMPWG was not written by the group, but by its chair only. David Walker is deputy chief medical officer and he had clearly listened. Here are some quotations.
The good thing about the European laws is that
"This legislation effectively banned the importation and sale of large-scale manufactured herbal medicine products. This step severely limited the scope of some herbal practitioners to continue practising, particularly those from the Traditional Chinese Medicine (TCM) and Ayurvedic traditions."
The biggest loophole is that
"At present under UK law it is permitted for a herbal practitioner to see individual patients, offer diagnoses and prepare herbal treatments on their own premises, as long as these preparations do not contain banned or restricted substances. This is unchanged by the Traditional Herbal Medicinal Products Directive. "
Walker recognised frankly that there is essentially no good evidence that any herb, western or Chinese, works well enough to make an acceptable treatment. And importantly he, unlike Pittilo, realised that this precludes statutory regulation.
"There are a small number of studies indicating benefit from herbal medicine in a limited range of conditions but the majority of herbal medicine practice is not supported by good quality evidence. A great deal of international, primary research is of poor quality. "
"ts. Herbal medicine practice is therefore currently based upon traditional practice rather than science. It is difficult to differentiate good practice from poor practice on the basis of this evidence in a way that could establish standards for statutory regulation"
The second problem was the harms done by herbs. Herbalists, western and Chinese, have no satisfactory way of reporting side effects
" . . . there is very limited understanding of the risks to patient safety from herbal medicines and herbal practice. A review of safety data was commissioned from HMAC as part of this review. This review identified many anecdotal reports and case studies but little systematically collected data. Most herbal medicine products have not been through the rigorous licensing process that is required of conventional pharmaceutical products to establish their safety and efficacy. Indeed, only a small proportion have even been subject to the less rigorous Traditional Herbal Registration (THR) process. "
"The anecdotal evidence of risk to patients from herbal products in the safety review highlighted the prominence of manufactured herbal medicines in the high profile serious incidents which have been reported in recent years. Many of these reports relate to harm thought to be caused by industrially manufactured herbal products which contained either dangerous herbs, the wrong constituents, toxic contaminants or adulterants. All such industrially manufactured products are now only available under European regulations if their safety is assured through MHRA licensing or THR
accreditation; and specific dangerous herbs have been banned under UK law. This has weakened the case for introduction of statutory regulation as a further safety measure. "
Then Walker identified correctly the training dilemma. Although it seems obvious, this is a big advance for a government document. Degrees that teach nonsense are not good training: they are miseducation.
"The third issue is the identification of educational standards for training practitioners and the benchmarking of standards for accrediting practitioners. With no good data on efficacy or safety, it is difficult for practitioners and patients to understand or quantify the potential benefits and risks of a proposed therapeutic intervention. Training programmes could accredit knowledge and skills in some areas including pharmacology and physiology, professional ethics and infection control but without a credible evidence base relating to the safety and effectiveness of herbal medicine it is hard to see how they could form the basis of accreditation in this field of practice.
There are a number of educational university programmes offering courses in herbal medicine although the number has declined in recent years. Some of these courses are accredited by practitioner organisations which is a potential governance risk as the accreditation may be based on benchmarks established by tradition and custom rather than science.
"The herbal medicine sector is in a dilemma" is Walker’s conclusion.
"Some practitioners would like to continue to practise as
they do now, with no further regulation, and accept that their practice is based on tradition and personal experience rather than empirical science. The logical consequence of adopting this form of practice is that we should take a precautionary approach in order to ensure public safety. The public should be protected through consumer legislation to prevent false claims, restricting the use of herbal products which are known to be hazardous to health"
The problem with this is, if course, is that although there is plenty of law, it’s rarely enforced : see Most alternative medicine is illegal Trading Standards very rarely enforce the Consumer Protection Regulations (2008) but Walker is too diplomatic to mention that fact.
"The herbals sector must recognise that its overall approach (including the rationale for use of products and methods of treatment, education and training, and interaction with the NHS) needs to be more science and evidence based if in order to be established as a profession on the same basis as other groups that are statutorily regulated."
So what happens next?
In the short term nothing will happen.
The main mistake has been avoided: there wil be no statutory regulation.
The other options are (a) do nothing, or (b) go for accreditation of a voluntary register (AR) by the Professional Standards Authority for Health and Social Care (PSA). Walker ends up recommending the latter, but only after a lot more work (see pages 28-29 of report). Of particular interest is recommendation 5.
"As a first step it would be helpful for the sector organisations to develop an umbrella voluntary register that could support the development of standards and begin to collaborate on the collection of safety data and the establishment of an academic infrastructure to develop training and research. This voluntary register could in due course seek accreditation from the Professional Standards Authority for Health and Social Care (PSA)."
So it looks as though nothing will happen for a long time, and herbalists and TCM may end up with the utterly ineffectual PSA. After all, the PSA have accredited voluntary registers of homeopaths, so clearly nothing is too delusional for them. It’s very obvious that, unlike Walker, the PSA are quite happy to ignore the training dilemma.
Omissions from the report
Good though this report is, by Department of Health standards, it omits some important points.
Endangered species and animal cruelty aren’t mentioned in the report. Traditional Chinese medicine, and its variants, are responsible for the near-extinction of rhinoceros, tiger and other species because of the superstitious belief that they have medicinal value. It’s not uncommon to find animal parts in Chinese medicines sold in the UK despite it being illegal
And the unspeakably cruel practice of farming bears to collect bile is a direct consequence of TCM.
A bile bear in a “crush cage” on Huizhou Farm, China (Wikipedia)
Statutory regulation of Chiropractors
The same arguments used in Walker’s report to deny statutory regulation of herbalism, would undoubtedly lead to denial of statutory regulation of chiropractors. The General Chiropractic Council was established in 1994, and has a status that’s the same as the General Medical Council. That was a bad mistake. The GCC has not protected the public, in fact it has acted as an advertising agency for chiropractic quackery.
Perhaps Prof. Walker should be asked to review the matter.
You can also read minutes of the HMPWG meetings (and here). But, as usual, all the interesting controversies have been sanitised.
Edzard Ernst has also commented on this topic: Once again: the regulation of nonsense will generate nonsense – the case of UK herbalists.
This article has appeared, in nearly identical form, on the UK Conversation . You can leave comments there or here.
A constitutional monarch is purely ceremonial and plays no part in politics. Well actually in the UK it isn’t quite as simple as that. The first problem is that we have no constitution. Things haven’t changed much since the 19th century when Walter Bagehot said "the Sovereign has, under a constitutional monarchy… three rights—the right to be consulted, the right to encourage, the right to warn."
These are not inconsiderable powers in a country which is meant to be run by elected representatives. But nobody knows how these powers are used: it is all done in secret. Well, almost all. Charles, Prince of Wales, has been unusually public in expressing his views. He told a conference at St James’s Palace “I was accused once of being the enemy of the Enlightenment” “I felt proud of that.” That’s a remarkable point of view for someone who, if he succeeds, will become the patron of that product of the age of enlightenment, the Royal Society.
I have no doubt that Prince Charles means well. He can’t be blamed for his lack of education. But his views on medicine date from a few centuries ago, and he has lost no opportunity to exploit his privileged position to proclaim them.
Euphemisms for quackery
He set up the Prince’s Foundation for Integrated Health (PFIH) to promote his views. ( “Integrated”, in this context, is, of course, just the latest euphemism for “alternative” or “quack”.) When the Foundation collapsed because of a financial scandal in 2010, it was replaced by the “College of Medicine”. The name changed, but not the people behind it. Initially this phoenix was to be named the “College of Integrated Health”, but by this time the prince’s views on medicine had become sufficiently discredited that the word “integrated” was quickly dropped. This might be thought less than frank, but it is just employment of the classic bait and switch technique, beloved by used car salesmen.
His views were well publicised in a PFIH publication, “Complementary Healthcare: a Guide for Patients”. That volume either omitted or misrepresented the evidence about the one question that matters most to patients – does the treatment work or not? It caused me to write a much shorter, but more accurate, version, the Patients’ Guide to Magic Medicine. The PFIH guide was arguably a danger to public health. When, very properly, it was criticised by Edzard Ernst, a letter was sent from from the prince’s private secretary to Ernst’s vice-chancellor, Steve Smith. Instead of defending Ernst’s public spirited action, Smith instituted disciplinary proceedings against Ernst that lasted for a year. The prince had intervened directly in the affairs of the university. Steve Smith was rewarded with a knighthood in 2011.
None of this criticism has dimmed the prince’s enthusiasm for barmy medical ideas. He is well known to write many letters to government ministers to try to persuade them to adopt his ideas in a whole range of areas. In July 2013, the Minister of Health, Jeremy Hunt, visited the prince at Clarence House. The visit was reported to be to persuade the minister to defend homeopathy, though it was more likely to have been to press the case to confer a government stamp of approval on herbalists and traditional Chinese Medicine practitioners by giving them statutory regulation. This is a matter that was recently raised again in parliament by Charles’ greatest ally, David Tredinnick MP (Con, Bosworth) who got into trouble for charging astrology software to expenses. We shall never know what pressure was applied. A ruling of the Information Commissioner judged, reasonably enough, that there was public interest in knowing what influences were being brought to bear on public policy. But the Attorney General overruled the judgement on the grounds that “Disclosure of the correspondence could damage The Prince of Wales’ ability to perform his duties when he becomes King.” That, of course, is exactly what we are worried about.
Influence on politics
The prince’s influence seems to be big in the Department of Health (DH). He was given £37,000 of taxpayers’ money to produce his guide, and an astonishing £900,000 to prepare the ground for the setting up of the hapless self-regulator, the Complementary and Natural Healthcare Council (CNHC, also known as Ofquack). When NHS Choices (itself set up by DH to assess evidence) tried to rewrite its web page about that most discredited of all forms of quackery, homeopathy, officials in DH referred the new advice to Michael Dixon, the medical director of the Prince’s Foundation and, were it not for the Freedom of Information act, the DH would have caused inaccurate information to be provided. The DH has a chief medical officer and two scientific advisors, but prefers to take the advice of the Prince of Wales.
The Prince of Wales’ business, Duchy Originals, has been condemned by the Daily Mail, (of all places) for selling unhealthy foods. And when his business branched into selling quack “detox” and herbal nonsense he found himself censured by both the MHRA and the Advertising Standards Authority (ASA) for making unjustifiable medical claims for these products.
Ainsworth’s homeopathic pharmacy is endorsed by both Prince Charles and the Queen: it has two Royal Warrants. They sell “homeopathic vaccines” for meningitis, measles, rubella and whooping cough. These “vaccines” contain nothing whatsoever so they are obviously a real danger to public health. Despite the fact that Ainsworth’s had already been censured by the ASA in 2011 for selling similar products, Ainsworth’s continued to recommend them with a “casual disregard for the law”. The regulator (the MHRA) failed to step in to stop them until it was eventually stirred into action by a young BBC reporter, Sam Smith, made a programme for BBC South West. Then, at last, the somnolent regulator was stirred into action. The MHRA “told Ainsworths to stop advertising a number of products” (but apparently not to stop making them or selling them). They still sell Polonium metal 30C and Swine Meningitis 36C, and a booklet that recommends homeopathic “vaccination”. Ainsworth’s sales are no doubt helped by the Royal Warrants. The consequence is that people may die of meningitis. In 2011, the MHRA Chief Executive Professor Kent Woods, was knighted.
It runs in the family
The Prince of Wales is not the only member of the royal family to be obsessed with bizarre forms of medicine. The first homeopath to the British royal family, Frederick Quin, was a son of the Duchess of Devonshire (1765-1824). Queen Mary (1865-1953), wife of King George V, headed the fundraising efforts to move and expand the London Homeopathic Hospital.
King George VI was so enthusiastic that in 1948 conferred the royal title on the London Homeopathic Hospital. The Queen Mother loved homeopathy too (there is no way to tell whether this contributed to her need for a colostomy in the 1960s).
The present Queen’s homeopathic physician is Peter Fisher, who is medical director of what, until recently was called the Royal London Homeopathic Hospital (RLHH). In 2010 that hospital was rebranded as the Royal London Hospital for Integrated Medicine (RLHIM) in another unsubtle bait and switch move.
The RLHIM is a great embarrassment to the otherwise excellent UCLH Trust. It has been repeatedly condemned by the Advertising Standards Authority for making false claims. As a consequence, it has been forced to withdraw all of its patient information.
The patron of the RLHIM is the Queen, not the Prince of Wales. It is hard to imagine that this anachronistic institution would still exist if it were not for the influence, spoken or unspoken, of the Queen. Needless to say we will never be told.
The Queen and Peter Fisher
Observer 8 April 2007
The attorney general, while trying to justify the secrecy of Charles’ letters, said
“It is a matter of the highest importance within our constitutional framework that the Monarch is a politically neutral figure”.
Questions about health policy are undoubtedly political, and the highly partisan interventions of the prince in the political process make his behaviour unconstitutional. They endanger the monarchy itself. Whether that matters depends on how much you value tradition and how much you value the tourist business generated by the Gilbert & Sullivan flummery at which royals excel.
The least that one can ask of the royal family is that they should not endanger the health of the nation. If I wanted to know the winner of the 2.30 at Ascot, I’d ask a royal. For any question concerning science or medicine I’d ask someone with more education.
Here is some more interesting reading
Michael Baum’s “An open letter to the Prince of Wales: with respect, your highness, you’ve got it wrong”
Gerald Weissman’s essay Homeopathy: Holmes, Hogwarts, and the Prince of Wales.
Channel 4 TV documentary HRH “meddling in politics”
Observer April 2007 "Royals’ favoured hospital at risk as homeopathy backlash gathers pace. The Queen loves it. But alternative medicine centre’s future looks uncertain as more NHS trusts axe funding"
A recent post, A right royal cock-up, got a lot more press attention than I’d expected. Perhaps I should have realised that the mainstream media are fascinated with anything that involves royalty. Here is my last word on that topic.
My reasons for writing about it had very little to do with royalty. I was elected to the Royal Society in 1985 and I’ve tolerated the odd voting forms, and the election of Royal Fellows, in silence for the last 27 years. What made me speak out this time was almost entirely to do with Andrew’s record of dubious behaviour. For me, it was a moral question, not a question of royalty per se.
The election of Prince Andrew (as a "Royal Fellow", not on scientific grounds) attracted 171 votes and 1128 non-responders. I was curious to know why so many people failed to vote. I was also curious about the statement made to the Sunday Times
"David’s [Colquhoun] views about our royal connections are very much in a minority"
Since I don’t recall being asked, I’m baffled about what data (if any) on which that statement was based. There was only one way to find out. To ask. The following email was sent at around 5 pm on Friday 17 May.
Subject: A very quick question about the election of Royal Fellows
In the light of the recent publicity surrounding the “election” of Prince Andrew as a Royal Fellow, I thought that, because so few people voted, it would be interesting to know the views of all fellows on this tradition. This mail is being sent to the 1197 fellows whose email address is given in the Year Book.
All you need to do is to hit reply and put YES or NO next to the following two questions. Only the total numbers are interesting. I promise not to reveal how anyone voted.
1) Do you think that the time has come to discontinue the tradition of electing Royal Fellows?
2) Do you think the election of Prince Andrew, in particular, has harmed the reputation of the Royal Society?
NB These questions do not refer to the monarch as patron (but if you have an opinion about that. please say so).
The intention was to word it as neutrally as possible. Few people expressed an opinion about the monarch as patron. I see no harm in continuing that tradition myself.
First, the Year Book is out of date. 106 emails bounced, several were "out of office", and a few recipients had died. So about 1080 emails should have arrived. I have no way of knowing how many were opened and read.
After one week, 324 replies had arrived, almost twice as many as the 171 votes cast in the original ballot. A couple of responses were surprisingly abusive. More were supportive. Most made no comment. 70% of those mailed didn’t respond. The 30% return rate is certainly a flaw, tnough not as big a flaw as the 13% return rate in the orginal poll,
Perhaps 30% isn’t so surprising. A weekly newsletter goes out to all UCL staff, and it has interesting information, though a bit too PR-like for my taste. But I’m told that 50% of emails sent out are never even opened, never mind read.
The results were as follows.
Of 302 who answered question 1, 131 (43%) said YES
Of 284 who answered question 2, 151 (53%) said YES
It was noticeable that those who work outside the UK were distinctly more likely to say NO. Perhaps they are unaware of the extensive press coverage about Andrew in the UK? 54 answers were received from people with .edu addresses, 32% yes for question 1, and 38% yes on question 2. If these are excluded on the grounds that they are unlikely to be aware of the problems, the results are
Of 248 who answered question 1, 114 (46%) said YES
Of 239 who answered question 2, 134 (56%) said YES
It might also be relevant almost half the fellows are 70 years old or older and 80% of fellows are 60 or older. That’s not surprising because very few people are elected at younger than 40, many are much older, and once in, you are in for life.
What can we conclude?
(1) 70% of those mailed have little interest in the politics of the RS, and there is no way to know whether they even opened my mail,
(2) Roughly half of those who expressed an opinion agreed with me
(3) it is not true that "David’s [Colquhoun] views about our royal connections are very much in a minority".
It seems to me that these numbers provide a good case for the RS Council to consider whether or not it is a good idea to continue to nominate Royal Fellows.
One more thing
The Sunday Times was also told
"The Duke of York is beloved by the tabloids but he has always had a robust defence in these issues . . . I think David is quite wrong to raise that"
It is most certainly not true that Andrew’s reputation is bad only in tabloid newspapers.
Try this leader in the Times (March 2011) “Undiplomatic Envoy. Prince Andrew’s friendship with a convicted US financier is an embarrassment. He should resign as a trade envoy“. [pdf]There are many more reports like that in the Times.
The most royalist of Conservative broadsheets, the Daily Telegraph, broke the story of abuse of aircraft and published Timeline: the Duke of York’s questionable friends. And the Telegraph’s chief reporter wrote "Sack the Duke of York as trade envoy, says former ambassador". And in 2012, the Telegraph wrote "Money laundering probe puts spotlight on the £15 million sale of the Duke of York’s home"
In March 2011, Channel 4 News wrote “Prince Andrew: ‘Cheerleader in chief for the arms industry‘
The Guardian has been critical since 2004. And of course it was the Guardian who published the cables that revealed Andrew’s curious attitude to bribery in arms deals.
These are not tabloids. The fact that every newspaper has written this sort of thing is what caused me to worry that his election would not go down well with the public. One of the most alarming aspects of the affair was the comments left by readers on the various newspaper articles. They did not give the impression that the public was as impressed by the Royal Society as its fellows tend to be. That is bad for everyone because the society does much good work, in funding science (in particular the excellent University Research Fellowships which give young scientists five years of independence).
I do sometimes wonder about the value of prizes and honours. My attitude to them is very much like that of one of my great scientific heroes, Richard Feynman. Watch this.
26 May 2013 The Sunday Times was onto the story quickly again, with a short piece. The cartoon isn’t totally appropriate (for me) since I’ve said repeatedly that it is Andrew’s morals that worry me, far more than his royalty.
It’s hard to know what to make of David Tredinnick MP (Cons, Bosworth). He is certainly an extreme example of the scientific ignorance of our parliamentary representatives, but he isn’t alone in that. Our present minister of Education, Michael Gove, memorably referred to Newton’s Laws of Thermodynamics, blissfully unaware that thermodynamics was a 19th century development. And our present Minister of Health seems to think that magic water cures diseases.
But Mr Treddinick breaks every record for anti-scientific nonsense. That, no doubt, is why he was upset by the recent revision of come NHS Choices web pages, so that they now give a good account of the evidence (that’s their job, of course). They did that despite two years of obstruction by the Department of Health. which seemed to think that it was appropriate to take advice from Michael Dixon of the Prince’s Foundation for integrated Health. That shocking example of policy based evidence was revealed on this blog, and caused something of a stir.
Treddinick’s latest letter
A copy of a letter from Mr Tredinnick to the Minister of Health, Jeremy Hunt, has some into my possession by a tortuous route [download the letter]. It’s a corker. Here are a few quotations.
"1. UKIP moving onto our ground
Attached is an extract from a recent UKIP policy statement. The position which UKIP has taken is one with which most of our Daily Mail reading supporters of complementary medicine would agree."
It seems that Treddinick’s preferred authority on medicine is now Nigel Farage, leader of the UK’s far right party. UKIP’s policy on health is appended to the letter, and it’s as barmy as most of the other things they say.
"2. Herbal Medicine
. . .there is very real concern that the Government will not regulate Herbal Medicine and Traditional Chinese Medicine. The current situation is unacceptable, because herbal practitioners need regulation and cannot function as herbal therapists, nor can they cannot obtain stocks of their herbal remedies, without it.
This refers to a saga that has been running for at least 10 years. Herbalists are desperate to get a government stamp of approval by getting statutory regulation, much like real doctors have, despite the fact that they make money by selling sick people "an unknown dose of an ill-defined drug, of unknown effectiveness and unknown safety" (as quoted recently in the House of Lords).
Even the US National Center for Complementary and Alternative Medicine (NCCAM) doesn’t claim that a single herbal treatment is useful. The saga of herbal regulation is long and tedious. The short version is that a very bad report, The Pittilo report, recommended regulation of herbalists. After years of prevarication, Andrew Lansley ignored the impartial scientific advice and yielded to the pressure from the herbal industry to accept the Pittilo report. But still nothing has happened.
Could it be that even Jeremy Hunt realises, deep down, that the regulation of nonsense is a nonsense that would harm the public?
We can only hope that a letter from Mr Tredinnick is the kiss of death. Perhaps his continuous pestering will only reinforce the doubts that seem to exist at the Department of Health.
Then Tredinnick returns (yawn) to his obsession with magic water. He vents his rage at the now excellent NHS Choices page on homeopathy.
"Recently this wording has been removed and instead a comment by the Chief Medical Officer that homeopathy is placebo inserted in its place, as well as links to external organisations which campaign against homeopathy. For instance, there is a link to the Sense About Science website, and Caroline Finucane, who is Editor of new content at NHS Choices, also writes for the Sense About Science website. This is an organisation which has no expertise in homeopathy and traces its roots back to the ultra-left Revolutionary Communist Party (RCP)."
"I respectfully suggest that the original wording be reinstated and these links to external organisations be removed or changed to ensure a balanced view.".
So it seems that he prefers the medical views of Nigel Farage and the Prince of Wales to those of the Chief Medical Officer and the government’s chief scientist. Disgracefully, Tredinnick picks out one particular employee of NHS Choices among many, and one who does an excellent job. And he raises the hoary old myth that Sense About Science is a communist organisation. Odd, since others accuse it of being neo-libertarian. The actual history is here. The organisation that is a bit too libertarian for my taste is Spiked Online. I haven’t agreed with every word that Sense about Science has printed, but they have a totally honest belief in evidence.
To drag in the name of one person out of many, and to justify it by a false history shows, once again, how very venomous and vindictive the advocates of delusional medicine can be when they feel cornered.
A bit more information about Mr Treddinick
This is what the BBC News profile says about him.
David Tredinnick is an old style Conservative MP, being an Eton-educated former Guards officer, who has sat in the Commons since 1987.
However, his ambition for high office was thwarted by his role in one of the sleaze stories which helped to sink the Major government. He accepted £1,000 from an undercover reporter to ask parliamentary questions about a fictitious drug. He was obliged to resign from his role as a PPS and was suspended from the Commons for 20 sitting days. He has not sat on the frontbench since.
He is an orthodox Conservative loyalist, though he is more supportive of the European Union than many of his colleagues.
He has, however, carved himself a niche as the Commons’ most enthusiastic supporter of complementary medicine. He has wearied successive health secretaries with his persistent advocacy of any and all homeopathic remedies. He has also supported their use in prisons and even suggested them as an aid in alleviating the foot and mouth crisis.
Tredinnick has also asserted that he was aware of a psychiatric hospital that doubled its staff at full moon (this is an old urban myth, and is, of course, quite untrue).
His advocacy of homeopathic borax as a way to control the 2001 epidemic of foot and mouth diease can be read here. Luckily it was ignored by the government. I hope his latest letter will be treated similarly.
Picture of David Tredinnick MP from the Conservative Party
The Scottish Universities Medical Journal asked me to write about the regulation of alternative medicine. It’s an interesting topic and not easy to follow because of the veritable maze of more than twenty overlapping regulators and quangos which fail utterly to protect the public against health fraud. In fact they mostly promote health fraud. The paper is now published, and here is a version with embedded links (and some small updates).
We are witnessing an increasing commercialisation of medicine. It’s really taken off since the passage of the Health and Social Security Bill into law. Not only does that mean having NHS hospitals run by private companies, but it means that “any qualified provider” can bid for just about any service. The problem lies, of course, in what you consider “qualified” to mean. Any qualified homeopath or herbalist will, no doubt, be eligible. University College London Hospital advertised for a spiritual healer. The "person specification" specified a "quallfication", but only HR people think that a paper qualification means that spiritual healing is anything but a delusion.
The vocabulary of bait and switch
First, a bit of vocabulary. Alternative medicine is a term that is used for medical treatments that don’t work (or at least haven’t been shown to work). If they worked, they’d be called “medicine”. The anti-malarial, artemesinin, came originally from a Chinese herb, but once it had been purified and properly tested, it was no longer alternative. But the word alternative is not favoured by quacks. They prefer their nostrums to be described as “complementary” –it sounds more respectable. So CAM (complementary and alternative medicine became the politically-correct euphemism. Now it has gone a stage further, and the euphemism in vogue with quacks at the moment is “integrated” or “integrative” medicine. That means, very often, integrating things that don’t work with things that do. But it sounds fashionable. In reality it is designed to confuse politicians who ask for, say, integrated services for old people.
Put another way, the salespeople of quackery have become rather good at bait and switch. The wikepedia definition is as good as any.
Bait-and-switch is a form of fraud, most commonly used in retail sales but also applicable to other contexts. First, customers are “baited” by advertising for a product or service at a low price; second, the customers discover that the advertised good is not available and are “switched” to a costlier product.
As applied to the alternative medicine industry, the bait is usually in the form of some nice touchy-feely stuff which barely mentions the mystical nonsense. But when you’ve bought into it you get the whole panoply of nonsense. Steven Novella has written eloquently about the use of bait and switch in the USA to sell chiropractic, acupuncture, homeopathy and herbal medicine: "The bait is that CAM offers legitimate alternatives, the switch is that it primarily promotes treatments that don’t work or are at best untested and highly implausible.".
The "College of Medicine" provides a near-perfect example of bait and switch. It is the direct successor of the Prince of Wales’ Foundation for Integrated Health. The Prince’s Foundation was a consistent purveyor of dangerous medical myths. When it collapsed in 2010 because of a financial scandal, a company was formed called "The College for Integrated Health". A slide show, not meant for public consumption, said "The College represents a new strategy to take forward the vision of HRH Prince Charles". But it seems that too many people have now tumbled to the idea that "integrated", in this context, means barmpottery. Within less than a month, the new institution was renamed "The College of Medicine". That might be a deceptive name, but it’s a much better bait. That’s why I described the College as a fraud and delusion.
Not only did the directors, all of them quacks, devise a respectable sounding name, but they also succeeded in recruiting some respectable-sounding people to act as figureheads for the new organisation. The president of the College is Professor Sir Graham Catto, emeritus professor of medicine at the University of Aberdeen. Names like his make the bait sound even more plausible. He claims not to believe that homeopathy works, but seems quite happy to have a homeopathic pharmacist, Christine Glover, on the governing council of his college. At least half of the governing Council can safely be classified as quacks.
So the bait is clear. What about the switch? The first thing to notice is that the whole outfit is skewed towards private medicine: see The College of Medicine is in the pocket of
Crapita Capita. The founder, and presumably the main provider of funds (they won’t say how much) is the huge outsourcing company, Capita. This is company known in Private Eye as Crapita. Their inefficiency is legendary. They are the folks who messed up the NHS computer system and the courts computer system. After swallowing large amounts of taxpayers’ money, they failed to deliver anything that worked. Their latest failure is the court translation service.. The president (Catto), the vice president (Harry Brunjes) and the CEO (Mark Ratnarajah) are all employees of Capita.
The second thing to notice is that their conferences and courses are a bizarre mixture of real medicine and pure quackery. Their 2012 conference had some very good speakers, but then it had a "herbal workshop" with Simon Mills (see a video) and David Peters (the man who tolerates dowsing as a way to diagnose which herb to give you). The other speaker was Dick Middleton, who represents the huge herbal company, Schwabe (I debated with him on BBC Breakfast), In fact the College’s Faculty of Self-care appears to resemble a marketing device for Schwabe.
Why regulation isn’t working, and can’t work
There are various levels of regulation. The "highest" level is the statutory regulation of osteopathy and chiropractic. The General Chiropractic Council (GCC) has exactly the same legal status as the General Medical Council (GMC). This ludicrous state of affairs arose because nobody in John Major’s government had enough scientific knowledge to realise that chiropractic, and some parts of osteopathy, are pure quackery,
The problem is that organisations like the GCC function more to promote chiropractic than to regulate them. This became very obvious when the British Chiropractic Association (BCA) decided to sue Simon Singh for defamation, after he described some of their treatments as “bogus”, “without a jot of evidence”.
In order to support Singh, several bloggers assessed the "plethora of evidence" which the BCA said could be used to justify their claims. When, 15 months later, the BCA produced its "plethora" it was shown within 24 hours that the evidence was pathetic. The demolition was summarised by lawyer, David Allen Green, in The BCA’s Worst Day.
In the wake of this, over 600 complaints were made to the GCC about unjustified claims made by chiropractors, thanks in large part to heroic work by two people, Simon Perry and Allan Henness. Simon Perry’s Fishbarrel (browser plugin) allows complaints to be made quickly and easily -try it). The majority of these complaints were rejected by the GCC, apparently on the grounds that chiropractors could not be blamed because the false claims had been endorsed by the GCC itself.
My own complaint was based on phone calls to two chiropractors, I was told such nonsense as "colic is down to, er um, faulty movement patterns in the spine". But my complaint never reached the Conduct and Competence committee because it had been judged by a preliminary investigating committee that there was no case to answer. The impression one got from this (very costly) exercise was that the GCC was there to protect chiropractors, not to protect the public.
The outcome was a disaster for chiropractors, wno emerged totally discredited. It was also a disaster for the GCC which was forced to admit that it hadn’t properly advised chiropractors about what they could and couldn’t claim. The recantation culminated in the GCC declaring, in August 2010, that the mythical "subluxation" is a "historical concept " "It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease.". Subluxation was a product of the fevered imagination of the founder of the chiropractic cult, D.D. Palmer. It referred to an imaginary spinal lesion that he claimed to be the cause of most diseases. .Since ‘subluxation’ is the only thing that’s distinguished chiropractic from any other sort of manipulation, the admission by the GCC that it does not exist, after a century of pretending that it does, is quite an admission.
The President of the BCA himself admitted in November 2011
“The BCA sued Simon Singh personally for libel. In doing so, the BCA began one of the darkest periods in its history; one that was ultimately to cost it financially,”
As a result of all this, the deficiencies of chiropractic, and the deficiencies of its regulator were revealed, and advertisements for chiropractic are somewhat less misleading. But this change for the better was brought about entirely by the unpaid efforts of bloggers and a few journalists, and not at all by the official regulator, the GCC. which was part of the problem. not the solution. And it was certainly not helped by the organisation that is meant to regulate the GCC, the Council for Health Regulatory Excellence (CHRE) which did nothing whatsoever to stop the farce.
At the other end of the regulatory spectrum, voluntary self-regulation, is an even worse farce than the GCC. They all have grand sounding "Codes of Practice" which, in practice, the ignore totally.
The Society of Homeopaths is just a joke. When homeopaths were caught out recommending sugar pills for prevention of malaria, they did nothing (arguably such homicidal advice deserves a jail sentence).
The Complementary and Natural Healthcare Council (CNHC) is widely know in the blogosphere as Ofquack. I know about them from the inside, having been a member of their Conduct and Competence Committee, It was set up with the help of a £900,000 grant from the Department of Health to the Prince of Wales, to oversee voluntary self-regulation. It fails utterly to do anything useful.. The CNHC code of practice, paragraph 15 , states
“Any advertising you undertake in relation to your professional activities must be accurate. Advertisements must not be misleading, false, unfair or exaggerated”.
When Simon Perry made a complaint to the CNHC about claims being made by a CNHC-registered reflexologist, the Investigating Committee upheld all 15 complaints. But it then went on to say that there was no case to answer because the unjustified claims were what the person had been taught, and were made in good faith.
This is precisely the ludicrous situation which will occur again and again if reflexologists (and many other alternative therapies) are “accredited”. The CNHC said, correctly, that the reflexologist had been taught things that were not true, but then did nothing whatsoever about it apart from toning down the advertisements a bit. They still register reflexologists who make outrageously false claims.
Once again we see that no sensible regulation is possible for subjects that are pure make-believe.
The first two examples deal (or rather, fail to deal) with regulation of outright quackery. But there are dozens of other quangos that sound a lot more respectable.
European Food Standards Agency (EFSA). One of the common scams is to have have your favourite quack treatment classified as a food not as a medicine. The laws about what you can claim have been a lot laxer for foods. But the EFSA has done a pretty good job in stopping unjustified claims for health benefits from foods. Dozens of claims made by makers of probiotics have been banned. The food industry, needless to say, objects very strongly to be being forced to tell the truth. In my view, the ESFA has not gone far enough. They recently issued a directive about claims that could legally be made. Some of these betray the previously high standards of the EFSA. For example you are allowed to say that "Vitamin C contributes to the reduction of tiredness and fatigue" (as long as the product contains above a specified amount of Vitamin C. I’m not aware of any trials that show vitamin C has the slightest effect on tiredness or fatigue, Although these laws do not come into effect until December 2012, they have already been invoked by the ASA has a reason not to uphold a complaint about a multivitamin pill which claimed that it “Includes 8 nutrients that can contribute to the reduction in tiredness and fatigue”
The Advertising Standards Authority (ASA). This is almost the only organisation that has done a good job on false health claims. Their Guidance on Health Therapies & Evidence says
"Whether you use the words ‘treatment’, ‘treat’ or ‘cure’, all are likely to be seen by members of the public as claims to alleviate effectively a condition or symptom. We would advise that they are not used"
"Before and after’ studies with little or no control, studies without human subjects, self-assessment studies and anecdotal evidence are unlikely to be considered acceptable"
"Before and after’ studies with little or no control, studies without human subjects, self-assessment studies and anecdotal evidence are unlikely to be considered acceptable"
They are spot on.
The ASA’s Guidance for Advertisers of Homeopathic Services is wonderful.
"In the simplest terms, you should avoid using efficacy claims, whether implied or direct,"
"To date, the ASA has have not seen persuasive evidence to support claims that homeopathy can treat, cure or relieve specific conditions or symptoms."
That seems to condemn the (mis)labelling allowed by the MHRA as breaking the rules.. Sadly, though, the ASA has no powers to enforce its decisions and only too often they are ignored. The Nightingale collaboration has produced an excellent letter that you can hand to any pharmacist who breaks the rules
The ASA has also judged against claims made by "Craniosacral therapists" (that’s the lunatic fringe of osteopathy). They will presumably uphold complaints about similar claims made (I’m ashamed to say) by UCLH Hospitals.
The private examination company Edexcel sets exams in antiscientific subjects, so miseducating children. The teaching of quackery to 16 year-olds has been approved by a maze of quangos, none of which will take responsibility, or justify their actions. So far I’ve located no fewer than eight of them. The Office of the Qualifications and Examinations Regulator (OfQual), Edexcel, the Qualifications and Curriculum Authority (QCA), Skills for Health, Skills for Care, National Occupational Standards (NOS), private exam company VTCT and the schools inspectorate, Ofsted.. Asking any of these people why they approve of examinations in imaginary subjects meets with blank incomprehension. They fail totally to protect tha public from utter nonsense.
The Department of Education has failed to do anything about the miseducation of children in quackery. In fact it has encouraged it by, for the first time, giving taxpayers’ money to a Steiner (Waldorf) school (at Frome, in Somerset). Steiner schools are run by a secretive and cult-like body of people (read about it). They teach about reincarnation, karma, gnomes, and all manner of nonsense, sometimes with unpleasant racial overtones. The teachers are trained in Steiner’s Anthroposophy, so if your child gets ill at school they’ll probably get homeopathic sugar pills. They might well get measles or mumps too, since Steiner people don’t believe in vaccination.
Incredibly, the University of Aberdeen came perilously close to appointing a chair in anthroposophical medicine. This disaster was aborted by bloggers, and a last minute intervention from journalists. Neither the university’s regulatory mechanisms. nor any others, seemed to realise that a chair in mystical barmpottery was a bad idea.
Trading Standards offices and the Office of Fair Trading.
It is the statutory duty of Trading Standards to enforce the Consumer Protection Regulations (2008) This European legislation is pretty good. it caused a lawyer to write " Has The UK Quietly Outlawed “Alternative” Medicine?". Unfortunately Trading Standards people have consistently refused to enforce these laws. The whole organisation is a mess. Its local office arrangement fails totally to deal with the age of the internet. The situation is so bad that a group of us decided to put them to the test. The results were published in the Medico-Legal Journal, Rose et al., 2012. "Spurious Claims for Health-care Products: An Experimental Approach to Evaluating Current UK Legislation and its Implementation". They concluded "EU directive 2005/29/EC is
largely ineffective in preventing misleading health claims for consumer products in
Skills for Health is an enormous quango which produces HR style "competences" for everything under the son. They are mostly quite useless. But those concerned with alternative medicine are not just useless. They are positively harmful. Totally barmy. There are competences and National Occupational Standards for every lunatic made-up therapy under the sun. When I phoned them to discover who’d written them, I learned that the had been drafted by the Prince of Wales’ Foundation for Magic Medicine. And when I joked by asking if they had a competence for talking to trees, I was told, perfectly seriously, “You’d have to talk to LANTRA, the land-based organisation for that.”
That was in January 2008. A lot of correspondence with the head of Skills for Health got nowhere at all. She understood nothing and it hasn’t improved a jot.
This organisation costs a lot of taxpayers’ money and it should have been consigned to the "bonfire of the quangos" (but of course there was no such bonfire in reality). It is a disgrace.
The Quality Assurance Agency (QAA) is supposed to ensure the quality of university courses. In fact it endorses courses in nonsense alternative medicine and so does more harm than good. The worst recent failure of the QAA was in the case of the University of Wales: see Scandal of the University of Wales and the Quality Assurance Agency. The university was making money by validating thousands of external degrees in everything from fundamentalist theology to Chinese Medicine. These validations were revealed as utterly incompetent by bloggers, and later by BBC Wales journalist Ciaran Jenkins (now working for Channel 4).
The mainstream media eventually caught up with bloggers. In 2010, BBC1 TV (Wales) produced an excellent TV programme that exposed the enormous degree validation scam run by the University of Wales. The programme can be seen on YouTube (Part 1, and Part 2). The programme also exposed, incidentally, the uselessness of the Quality Assurance Agency (QAA) which did nothing until the scam was exposed by TV and blogs. Eventually the QAA sent nine people to Malaysia to investigate a dodgy college that had been revealed by the BBC. The trip cost £91,000. It could have been done for nothing if anyone at the QAA knew how to use Google.
The outcome was that the University of Wales stopped endorsing external courses, and it was soon shut down altogether (though bafflingly, its vice-chancellor, Marc Clement was promoted). The credit for this lies entirely with bloggers and the BBC. The QAA did nothing to help until the very last moment.
Throughout this saga Universities UK (UUK), has maintained its usual total passivity. They have done nothing whatsoever about their members who give BSc degrees in anti-scientific subjects. (UUK used to known as the Committee of Vice-Chancellors and Principals).
Council for Health Regulatory Excellence (CHRE), soon to become the PSAHSC,
Back now to the CHRE, the people who failed so signally to sort out the GCC. They are being reorganised. Their consultation document says
"The Health and Social Care Act 20122 confers a new function on the Professional Standards Authority for Health and Social Care (the renamed Council for Healthcare Regulatory Excellence). From November 2012 we will set standards for organisations that hold voluntary registers for people working in health and social care occupations and we will accredit the register if they meet those standards. It will then be known as an ‘Accredited Register’. "
They are trying to decide what the criteria should be for "accreditation" of a regulatory body. The list of those interested has some perfectly respectable organisations, like the British Psychological Society. It also contains a large number of crackpot organisations, like Crystal and Healing International, as well as joke regulators like the CNHC.
They already oversee the Health Professions Council (HPC) which is due to take over Herbal medicine and Traditional Chinese Medicine, with predictably disastrous consequences.
Two of the proposed criteria for "accreditation" appear to be directly contradictory.
Para 2.5 makes the whole accreditation pointless from the point of view of patients
2.5 It will not be an endorsement of the therapeutic validity or effectiveness of any particular discipline or treatment.
Since the only thing that matters to the patient is whether the therapy works (and is safe), accrediting of organisations that ignore this will merely give the appearance of official approval of crystal healing etc etc. This appears to contradict directly
A.7 The organisation can demonstrate that there either is a sound knowledge base underpinning the profession or it is developing one and makes that explicit to the public.
A "sound knowledge base", if it is to mean anything useful at all, means knowledge that the treatment is effective. If it doesn’t mean that, what does it mean?
It seems that the official mind has still not grasped the obvious fact that there can be no sensible regulation of subjects that are untrue nonsense. If it is nonsense, the only form of regulation that makes any sense is the law.
Please fill in the consultation. My completed return can be downloaded as an example, if you wish.
Medicines and Healthcare products Regulatory Agency (MHRA) should be a top level defender of truth. Its strapline is
"We enhance and safeguard the health of the public by ensuring that medicines and medical devices work and are acceptably safe."
The MHRA did something (they won’t tell me exactly what) about one of the most cruel scams that I’ve ever encountered, Esperanza Homeopathic Neuropeptide, peddled for multiple sclerosis, at an outrageous price ( £6,759 for 12 month’s supply). Needless to say there was not a jot of evidence that it worked (and it wasn’t actually homeopathic).
Astoundingly, Trading Standards officers refused to do anything about it.
The MHRA admit (when pushed really hard) that there is precious little evidence that any of the herbs work, and that homeopathy is nothing more than sugar pills. Their answer to that is to forget that bit about "ensuring that medicines … work"
Here’s the MHRA’s Traditional Herbal Registration Certificate for devils claw tablets.
The wording "based on traditional use only" has to be included because of European legislation. Shockingly, the MHRA have allowed them to relegate that to small print, with all the emphasis on the alleged indications. The pro-CAM agency NCCAM rates devil’s claw as "possibly effective" or "insufficient evidence" for all these indications, but that doesn’t matter because the MHRA requires no evidence whatsoever that the tablets do anything. They should, of course, added a statement to this effect to the label. They have failed in their duty to protect and inform the public by allowing this labelling.
But it gets worse. Here is the MHRA’s homeopathic marketing authorisation for the homeopathic medicinal product Arnicare Arnica 30c pillules
It is nothing short of surreal.
Since the pills contain nothing at all, they don’t have the slightest effect on sprains, muscular aches or bruising. The wording on the label is exceedingly misleading.
If you "pregnant or breastfeeding" there is no need to waste you doctor’s time before swallowing a few sugar pills.
"Do not take a double dose to make up for a missed one". Since the pills contain nothing, it doesn’t matter a damn.
"If you overdose . . " it won’t have the slightest effect because there is nothing in them
And it gets worse. The MHRA-approved label specifies ACTIVE INGREDIENT. Each pillule contains 30c Arnica Montana
No, they contain no arnica whatsoever.
It truly boggles the mind that men with dark suits and lots of letters after their names have sat for hours only to produce dishonest and misleading labels like these.
When this mislabeling was first allowed, it was condemned by just about every scientific society, but the MHRA did nothing.
The Nightingale Collaboration.
This is an excellent organisation, set up by two very smart skeptics, Alan Henness and Maria MacLachlan. Visit their site regularly, sign up for their newsletter Help with their campaigns. Make a difference.
The regulation of alternative medicine in the UK is a farce. It is utterly ineffective in preventing deception of patients.
Such improvements as have occurred have resulted from the activity of bloggers, and sometime the mainstream media. All the official regulators have, to varying extents, made things worse.
The CHRE proposals promise to make matters still worse by offering "accreditation" to organisations that promote nonsensical quackery. None of the official regulators seem to be able to grasp the obvious fact that is impossible to have any sensible regulation of people who promote nonsensical untruths. One gets the impression that politicians are more concerned to protect the homeopathic (etc, etc) industry than they are to protect patients.
Deception by advocates of alternative medicine harms patients. There are adequate laws that make such deception illegal, but they are not being enforced. The CHRE and its successor should restrict themselves to real medicine. The money that they spend on pseudo-regulation of quacks should be transferred to the MHRA or a reformed Trading Standards organisation so they can afford to investigate and prosecute breaches of the law. That is the only form of regulation that makes sense.
The shocking case of the continuing sale of “homeopathic vaccines” for meningitis, rubella, pertussis etc was highlighted in an excellent TV programme by BBC South West. The failure of the MHRA and the GPC do take any effective action is a yet another illustration of the failure of regulators to do their job. I have to agree with Andy Lewis when he concludes
“Children will die. And the fault must lie with Professor Sir Kent Woods, chairman of the regulator.”
Although many university courses in quackery have now closed, two subjects that hang on in a few places are western herbalism, and traditional Chinese medicine (including acupuncture). The University of Westminster still runs Chinese medicine, and Western herbal medicine (with dowsing). So do the University of Middlesex and University of East London.
Since the passing of the Health and Social Security Act, these people have been busy with their customary bait and switch tactics, trying to get taxpayers’ money. It’s worth looking again at the nonsense these people talk.
Take for example, the well known herbalist, Simon Mills. At one time he was associated with the University of Exeter, but no longer. Perhaps his views are too weird even for their Third Gap section (the folks who so misrepresented their results in a trial of acupuncture). Unsurprisingly, he was involved in the late Prince’s Foundation for Magic Medicine, and, unsurprisingly, he is involved with its successor, the "College of Medicine", where he spoke along similar lines. You can get a good idea about his views from the video of a talk that he gave at Schumacher College in 2005. It’s rather long, and exceedingly uncritical, so here’s a shorter version to which some helpful captions have been added.
That talk is weird by any standards. He says, apparently with a straight face, that "all modern medicines are cold in the third degree"..And with ginger and cinnamon "You can stop a cold, generally speaking, in its tracks" (at 21′ 30" in the video). This is simply not true, but he says it, despite the fact that the Plant Medicine with site (of which he’s a director) which he is associated gives them low ratings
Simon Mills is also a director of SustainCare. Their web site says
SustainCare Community Interest Company is a social enterprise set up to return health care to its owners: “learning to look after ourselves and our families in ways that make sense and do not cost the earth“. It is founded on the principle that one’s health is a personal story, and that illness is best managed when we make our health care our own. The enterprise brings clinical expertise, long experience of academia, education and business, and the connections and resources to deliver new approaches.
"As its own social enterprise contribution to this project Sustaincare set up and supported Café Sustain as a demonstration Intelligent Waiting Room at Culm Valley Integrated Centre for Health in Devon". (yes, that’s Michael Dixon, again]
In the talk (see video) Mills appears to want to take medicine back to how it was 1900 years ago, in the time of Galen. The oblique speaking style is fascinating. He never quite admits that he thinks all that nonsense is true, but presumably it is how he treats patients. Yet a person with these bizarre pre-scientific ideas is thought appropriate to advise the MHRA
It’s characteristic of herbalists that they have a very long list of conditions for which each herb is said to be good. The sort of things said by Mills differ little from the 1900-year old ideas of Galen, io the 17th century ideas of Culpepper.
You can see some of the latter in my oldest book, Blagrave’s supplement to Culpepper’s famous herbal, published in 1674.
See what he has to say about daffodils
It is "under the dominion of Mars, and the roots hereof are hot and dry almost in the third degree".
"The root, boyled in posset drink, and drunk, causeth vomiting, and is used with good successe in the beginning of Agues, especiallyTertians, which frequently rage in the spring-time: a plaister made of the roots with parched Barley meal, and applied to swellings and imposthumes do dissolve them; the juice mingled with hony, frankincense, wine and myrrhe, and dropped into the Eares, is good against the corrupt filth and running matter of the Eares; the roots made hollow and boyled in oyl doth help Kib’d heels [or here]: the juice of the root is good for Morphew, and discolourings of the skin."
It seems that daffodils would do a lot in 1674. Even herbalists don’t seem to use it much now. A recent herbal site describes daffodil as "poisonous".
But the descriptions are very like those used by present day herbalists, as you can hear in Simon Mills’ talk.
Chinese medicine is even less tested than western herbs. Not a single Chinese herb has been shown to be useful for treating anything (though in a very few case, they have been found to contain drugs that are useful when purified, notably the anti-malarial compound, artemesinin). They are often contaminated, some are dangerously toxic. And they contribute to the extinction of tigers and rhinoceros because of the silly myths that these make useful medicines. The cruelty of bear bile farming is legendary.
In a recent report in China Daily (my emphasis).
In a congratulation letter, Vice-Premier Li Keqiang called for integration of TCM and Western medicine.
TCM, as a time-honored treasure of Chinese civilization, has contributed to the prosperity of China and brought impacts to world civilization, Li said.
He also urged medical workers to combine the merits of TCM with contemporary medicine to better facilitate the ongoing healthcare reform in China.
The trade in Chinese medicines survives only for two reasons. One is that thay are a useful tool for promoting Chinese nationalism. The other is that they are big business. Both are evident in the vice-premier’s statement.
I presume that it’s the business bit that is the reason why London South Bank University (ranked 114 ou ot 114) that led to one of their main lecture theatres being decorated with pictures like this.“Mr Li Changchun awarding 2010 Confucius Institute of the year to LSBU Vice Chancellor” . I’ll bet Mr Li Changchun uses real medicine himself, as most Chinese who can afford it do.
Presumably, what’s taught in their Confucius Institute is the same sort of dangerous make-believe nonsense.that’s taught on other such courses.
The "College of Medicine" run a classical bait and switch operation. Their "First Thursday lectures" have several good respectable speakers, but then they have Andrew Flower, He is "a former president of the Register of Chinese Herbal Medicine, a medical herbalist and acupuncturist. He has recently completed a PhD exploring the role of Chinese herbal medicine in the treatment of endometriosis". He’s associated with the Avicenna Centre for Chinese Medicine, and with the University of Southampton’s quack division The only bit of research I could find by Andrew Flower was a Cochrane review, Chinese herbal medicine for endometriosis. The main results tell us
"Two Chinese RCTs involving 158 women were included in this review. Both these trials described adequate methodology. Neither trial compared CHM with placebo treatment."
But the plain language summary says
"This review suggests that Chinese herbal medicine (CHM) may be useful in relieving endometriosis-related pain with fewer side effects than experienced with conventional treatment."
It sounds to me as though people as partisan as the authors of this should not be allowed to write Cochrane reviews.
Flower’s talk is followed by one from the notorious representative of the herbal industry, Michael McIntyre, talking on Herbal medicine: A major resource for the 21st century. That’s likely to be about as objective as if they’d invited a GSK drug rep to talk about SSRIs.
The people at Kings College London Institute of Pharmaceutical Sciences are most certainly not quacks. They have made a database of chemicals found in traditional Chinese medicine. It’s sold by a US company, Chem-TCM and it’s very expensive (Commercial license: $3,740.00. Academic/government license: $1,850.00). Not much open access there. It’s a good idea to look at chemicals of plant origin, but only as long as you don’t get sucked into the myths. It’s only too easy to fall for the bait and switch of quacks (like TCM salespeople). The sample page shows good chemical and botanical information, and predicted (not observed) pharmacological activity. More bizarrely, it shows also analysis of the actions claimed by TCM people.
It does seem odd to me to apply sophisticated classification methods to things that are mostly myth.
The multiple uses claimed for Chinese medicines are very like the make-believe claims made for western herbs by Galen, Culpepper and (with much less excuse) by Mills.
They are almost all untrue, but their proponents are good salesmen. Don’t let them get a foot in your door.
10 June 2012. No sooner did this post go public when I can across what must be one of the worst herbal scams ever: “Arthroplex“
31 July 2012. Coffee is the subject of another entry in the 1674 edition of Blagrave.
Blagrave evidently had a lower regard for coffee than I have.
“But being pounded and baked, as do it to make the Coffee-liquor with, it then stinks most loathsomly, which is an argument of some Saturnine quality in it.”
“But there is no mention of an medicinal use thereof, by any Author either Antient of Modern”
Blagrave says also
“But this I may truly say of it [coffee]: Quod Anglorum Corpora quae huic liquori, tantopere indulgent, in Barbarorum naturam degenerasse videntur,”
This was translated expertly by Benet Salway, of UCL’s History department
“that the bodies of the English that indulge in this liquor to such an extent seem to degenerate into the nature of barbarians”
My boss, Lucia Sivolotti got something very like that herself. Be very impressed.
Salway suggested that clearer Latin would have been “quod corpora Anglorum, qui tantopere indulgent huic liquori, degenerasse in naturam barbarorum videntur”.
I’d have passed that on to Blagrave, but I can’t find his email address.
I much prefer Alfréd Rényi’s aphorism (often misattributed to Paul Erdös)
“A mathematician is a machine for turning coffee into theorems”
[Use Firefox if embedded videos do not show in Chrome]
Andrew Lansley’s Health Bill (HASSB) aims to change the NHS into something more like the US system, which gives worse results at twice the cost.
The only possible reason for wanting to do that is simple far-right ideology. No wonder that no hint was given of its intentions before the election.
On the contrary, David Cameron stated repeatedly that there would be no top-down reorganisation of the NHS. That turned out to be a straight lie.
“First let me tell you what we are not going to do. There will be no more of those pointless reorganisations that aim for change, but instead bring chaos.” [David Cameron speaking to Royal College of Nursing in 2009, before election].
We all know that money must be saved. But the two major disasters of the coalition government don’t save any money.
On the contrary, both tuition fees and NHS-wrecking will cost taxpayers’ money. The tuition fees are done (for the time being) but there is still time to save the NHS.
The best simple explanation that I’ve found is by Dr Max Pemberton in the Telegraph: Read this – and prepare to fight for your NHS. The Bill is three times longer than the 1946 Bill that brought the NHS into existence.
“The power to determine the services that make up the NHS will be transferred from the Secretary of State to newly created Clinical Commissioning Groups (CCGs), which are unelected. Members will include GPs but also company chief executives who can, if they wish, outsource decisions about the appropriate level of services offered to companies with commercial interests. This is what the Government means when it says it is handing GPs £60 billion of NHS money. ”
“Monitor. This quango is composed of unelected and unaccountable individuals. It will not have overarching responsibility – which the Government does currently – to ensure that everyone’s health needs are met.” “It will have the power to decide, on purely financial grounds, if an area loses its existing range of hospital services, such as A&E departments, with no duty to consider alternative provision.
“With so many different providers of health care created under this Bill, those with complex health care needs may not receive the joined-up medical care that the NHS now works hard to provide.”
“Less profitable patients – those requiring complex levels of care from multiple individuals and areas of expertise, for example – may be sidelined by these private companies. ”
“the Bill allows CCGs to contract out commissioning functions to private accountancy, health insurance and management consultant firms, which will be able to decide what care is provided free at the point of use through the NHS and what is not. This means that profit-making companies will be able to provide your clinical care and also decide what you’re entitled to under the NHS and from which care providers.” “There is the potential for commercial conflicts when the needs of shareholders come between doctors and patients. ”
“Providers, too, can reduce levels of service provision and entitlement to NHS-funded care and there are no restrictions on charging for non-NHS care.”
“Now, up to 49 per cent of income can be generated from private income. This means that almost half the beds currently used for NHS care could be given over to private patients.” “This could create a two-tier system in hospitals” and “create a conflict of interest, with hospitals having a clear incentive to encourage as many patients as possible to use the private half of their facilities. Moreover, hospitals can decide when to discharge patients. The requirement for coordinated discharge and aftercare of patients between health and social care is abolished in the Bill. “
Why is the bill needed at all?
Most people believe that there is no need for a bill. The real aim appears to be in part 3, which proposes a vast increase in private providers. Oliver Huitson says
“A US report comparing the health services of 7 major economies ranked the NHS 1st in terms of efficiency, and 2nd overall. The US, which has vast private sector involvement and much greater use of GP commissioning, was ranked last despite spending more than twice as much per head as the UK”
” Despite being ranked as one of the most efficient and equitable health services in the developed world, the Conservatives are determined to remodel it in the image of one of the least efficient – all in the name of “improving efficiency”.”
Although most GPs are in favour of having more say in what happens, even the first parts of the bill are a mess. They are advertised as reducing bureaucracy and reducing costs. According to the Financial Times, they do exactly the opposite.
“Here was the original NHS bureaucracy in graphic form”
Here is the new NHS bureaucracy in graphic form
Ed Miliband pointed out that the number of NHS statutory organisations was growing from 163 to 521 – including “health and wellbeing committees,” “national commissioning boards”, “clinical networks”, “clinical senates” and so on.
So much for reduced bureaucracy.
Who thinks this is not a good idea?
Almost everyone. Not just the BMA which Lansley dismisses as a Trade Union, despite the fact that now (unlike in 1948) the BMA is voting against the financial interests of its members.
The Royal College of General Practitioners says Drop the Bill. So do Royal College of Nursing. Royal College of Midwives, Faculty of Public Health, Chartered Society of Physiotherapists, the Patients’ Association, among others. Almost the only support left is from the NHS Alliance, a tiny organisation run by Michael Dixon, friend of the Prince of Wales and advocate of quack medicine. The NHS alliance ran its own poll. A total of 100 people have voted so far, 99 of them against the Alliance’s policy. Some support. A rather good infographic shows how the balance lies.
The BMA’s General Practitioners Committee, which represents all GPs in the UK says [read full letter]
“1. Formally reaffirms its opposition to the NHS Health and Social Care Bill;
2. Believes that if passed the Bill will be irreversibly damaging to the NHS as a public service, converting it into a competitive marketplace that will widen health inequalities and be detrimental to patient care; . . . .”
In contrast, the e-petition to the government, started by Dr Kailash Chand OBE, states simply that it “Calls on the Government to drop its Health and Social Care Bill.”. It now has over 167,000 signatories. But despite the fact that petitions with over 100,000 signatures are meant to trigger a debate in the House of Commons, the backbench business committee of MPs has decided not to debate the e-petition.
So many people have rallied to oppose the daftness that it’s invidious to single out names. Nonetheless special mentions must go to Clare Gerada (@clarercgp on Twitter) (chair of the RCGP), and to Clive Peedell (@cpeedell) (oncologist and co-chair NHS Consultants’ Association) -read his Bevan’s Run blog. Among academics, Allyson Pollock and Martin McKee have done superb work on the details.
Most telling of all, some of the people who started by supporting Lansley have changed their minds. One concern about the “any qualified provider” idea is that it could open the door to quackery. Any “qualified” homeopath could bid for business at a competitive rate -sugar pills don’t cost much. Michael Dixon is one such.
Dr Sam Everington of Tower Hamlets is another. Services provided by his practice include “referrals to Inside Out Health and Wellbeing Ltd“. This private company will sell you fraudulent scams like homeopathy and kinesiology at £50 per session, among other nonsense (according to Companies House, it was wound up on 17 January 2012). He’s also associated with the “College of Medicine” (the reincarnation of the Prince of Wales’ Foundation). See also, Dr Margaret McCartney’s blog. As chair of the first Clinical Commissioning Group (CCG) he was embraced by Cameron. His Bromley-by-Bow surgery was host for Andrew Lansley’s first speech as health secretary after the 2010 election, and also host to the Prince of Wales..
But now even Everington has turned against the Bill (read the full letter).
“Dear Prime Minister
The Board of NHS Tower Hamlets Clinical Commissioning Group ask you to reflect and to withdraw the Health and Social Care Bill.”
“We care deeply about the patients that we see every day and we believe the improvements we all want to see in the NHS can be achieved without the bureaucracy generated by the Bill.
Your government has interpreted our commitment to our patients as support for the bill. It is not.”
And, on 1st March, another request to drop the bill, from the East London Integrated Care (ELIC is a not-for-profit social enterprise which is owned and run by local people and health professionals”). Read the full letter.
“Thursday, 1 March 2012 N1 5LZ
Dear Prime Minister,
The Board of City & Hackney Clinical Commissioning Group (CCG) join Tower Hamlets
and most other GPs and nurses and ask you to withdraw the Health and Social Care Bill.”
Is it really privatisation?
If you feel reassured by Lansley’s assurances that his measures aren’t de facto privatisation, just watch this video. It reveals some of the network of lobby groups that are circling the NHS, eager to take your money. For example, the lobby group, Policy Exchange, “Cameron’s favourite”, co-founded by Francis Maude, a member of Cameron’s cabinet, and is lobbying for more private sector provision of NHS services. One of the companies that it’s taken money from is called Tribal, which wants to take over commissioning from GPs. One of the directors of Tribal has described Andrew Lansley’s reforms as being “denationalisation of health services in England”.
So you don’t need to listen to left-wingers. The industry itself is in no doubt that it’s privatisation, and it’s ready and waiting to grab our money..
And of all unlikely allies, the vice chair of the British Holistic Medical Association has written a powerful letter about how the bill really would result in privatisation.
The likely consequences have been put well by Ben Goldacre in his What will happen with the NHS bill, in 5 tweets. The following points are based partly on this.
- GPs know they’re being set up to fail by being given commissioning powers, which they have neither the time nor the expertise to do properly.
- After GPs fail, private commissioning expertise will be needed. Large private companies will be given the job and they will come to operate like health insurers.
- These large bodies, like public/private insurance companies, will be able to pick and choose patients. They will naturally prefer the ones from whom they can make the most money (and not the sick or the old). Note that there is no geographical responsibility in the bill
- Small differences will gradually emerge in what services they offer. Top up plans will become available. And that will be the end of the NHS in the form in which we know it.
The only way that the proposals make any sense at all is if the underlying aim is to destroy the NHS, in anything like its present form. I believe that Lansley’s aims are much more to do with his personal political ideologies than anything to do with health. Those ideologies are far to the right of anything envisaged by Margaret Thatcher.
The politics. Where are the Lib Dems?
I voted Lib Dem in 2010, and I said precisely why. Of course I didn’t expect they’d get a majority. They were just the party that I found least objectionable. Like so many others I watched with horror as the numbers came out. There was no other option but to form a coalition with Conservatives. Well, I’d have been happier with no coalition, but the danger of that producing an overall majority for Conservatives after a year or so made that a very risky option.
When the coalition formed I was alarmed by the prospects for both education and for the NHS. I was less alarmed by the latter, because Cameron had said so many times that he had no intention of messing with the NHS. That turned out to be a direct lie. I could scarcely believe it when Lansley produced a plan after the election for the biggest reorganisation ever in the NHS, something that had not been foreshadowed in any way in the Conservative manifesto. This was one of the most dishonest bits of political manoeuvring that I’ve ever encountered.
Clearly we were spending more than we could afford. What’s unforgivable is to do things that actually cost the taxpayer more than before. Such actions are quite the opposite of cuts. Yet they are being done in the two areas, than any others, that have got Lib Dem voters angry.
(a) The £9k tuition fees cost the taxpayer more than the £3k fees did, because of the financing arrangements. I can see no conceivable reason for spending more taxpayers’ money than before apart from (Conservative) political ideology. That’s done (for now) so back to the main topic of this post, the NHS.
(b) It seems inevitable that Lansley’s proposals will cost money, not save money. Presumably that was predicted in the risk register, the concealment of which is a disgrace. See Liberal Conspiracy and the Green Benches blogs. The Information Commissioner ordered the release of the risk register, but the coalition refused (so much for transparent government). They appealed so now it goes to an Information Tribunal.
An Early Day Motion in the House of Commons urged release. It was signed by only 16 Lib Dems.
The bill started to fall apart in a major way when, on February 6th, The Times reported that
“Andrew Lansley should be taken out and shot,” says a Downing Street source. “He’s messed up both the communication and the substance of the policy.”
But Cameron, instead of grasping the chance, decided to back a loser.
Some Lib Dems have stuck to their principles. For example
John Pugh MP, Co-Chair of the Lib Dem Parliamentary Health Committee, re-established the Beveridge group, and wrote a letter to parliamentarians to explain why.
Andrew George MP wrote Health Bill has no friends. Dignified withdrawal would be best.
On 13 February, hearts soared when Lib Dem peer Shirley Williams spoke out at last. She urged Lansley to drop part 3 of the bill, the part that deals with privatisation. The elation didn’t last long though. Nick Clegg told the BBC: “Andrew Lansley is the architect of the NHS bill. He cares passionately about the NHS. He’s the right man for the job and he must see it through.”. Yes, I know about Cabinet solidarity, but it’s hard to think of any surer way to lose elections than to make statements like that. Even many Conservatives don’t believe it: see, for example, Dr Rachel Joyce on Conservative Home.
On 24th February, the Lib Dem president, Tim Farron MP, spoke up at last. “Mr Farron told ITV the bill should have been “massively changed” or dropped earlier and he wanted plans for more competition in the NHS to be dropped”.
On 26 February, Nigel Crisp, described the bill as a confusing mess that risks setting the NHS back. Crisp was formerly NHS chief executive and the permanent secretary at the Department of Health from 2000 to 2006, and is now a crossbench peer. Like everyone else, he was ignored.
The elation about Shirley Williams intervention didn’t last long. On 27th February a joint letter from Williams and Clegg claimed that they’d fixed the bill. The letter was quickly subjected to a bullshitometer analysis, by Health Policy Insight. Bafflingly, Lansley declared in public that he’d “changed his mind” about the privatisation, while at the same time Lansley and Cameron claimed that nothing much had changed: see Downing Street in knots as it plays down Nick Clegg’s NHS concessions, and Paul Corrigan’s blog.
March 1st saw two more blows for Clegg and Lansley. First, as reported thus in the Independent.
“Graham Winyard, the former deputy Chief Medical Officer, resigned from the party in protest at the leadership’s backing for the Bill. Dr Winyard, who was chairman of Winchester Liberal Democrats until last year, told Mr Clegg in a letter: “It is just not sensible to impose this top-down reorganisation on an NHS struggling to meet the biggest financial challenge in its history. To continue to do so in the face of near unanimous opposition from patient, staff and professional organisations simply invites slow motion disaster both for the NHS and for the party.” He said that he had no option but to resign “with great sadness”. “
Then, also on 1st March, Dr Laurence Buckman, chairman of the BMA’s GPs committee, wrote to 22,000 GPs. [full letter]
- Believes the bill will compromise the role of GPs, and could cause irreparable damage to the relationship between GPs and their patients.
- Believes the bill to be complex, incoherent and not fit for purpose, and almost impossible to implement successfully, given widespread opposition across the NHS workforce.
- Believes that passing the bill will be an irresponsible waste of taxpayers’ money, which will be spent on unnecessary reorganisation rather than on patient care, as well as increasing the running costs of the NHS from the processes of competition, and transaction costs
The chaos that the Lib Dems now find themselves in is illustrated clearly by a post on Liberal Democrat Voice by Andrew Tennant. He’s apparently an unreconstructed 19th century Whig, masquerading as a 21st century liberal. The comments on the post reveal the mess the party has got itself into by refusing to drop the bill.
More to the point, look at the proper detailed analyses done by people who are a lot more knowledgeable than Andrew Tennant, or Andrew Lansley.
- RCGP Report Stage Briefing – Health and Social Care Bill February 2012
- Allyson Pollock explains, line by line, a lot of problems that “Recent amendments put forward by the Liberal Democrats do not address”.
- Statement on Liberal Democrat amendments
Prof Allyson Pollock, David Price, Peter Roderick, and Tim Treuherz
28 February 2012
- Royal College of Physicians, in The Lancet “What began as a ham-fisted attempt to modernise the NHS has become a grotesque political disaster for government.”
- The NHS bill could finish the health service – and David Cameron Polly Toynbee says it as it is.
- A big document by SOSNHS -great source of links Breaking the NHS.
There is one last chance for the Lib Dems to restore their reputation. Lib Dems hope to finally kill health reforms. “Liberal Democrat activists will defy Nick Clegg over the Government’s controversial health reforms by seeking to “kill” them at a party policy-making conference next week.”
Good luck to them. They could save the Lib Dems if they win. Much more importantly, they could save the NHS.
Sunday 4 March. Yet another story of corruption, this time in the Mail on Sunday.
“The head of the NHS regulator that is meant to ensure fairness when private-sector firms bid for public contracts is also the chairman of a huge company whose Health Service business is worth £80 million a year – and set to increase massively.
As the chairman of the NHS Co-operation and Competition Panel (CCP), Lord Carter of Coles is paid £57,000 for two days’ work each week. But his other role, as chairman of the UK branch of the American healthcare firm McKesson, is more generously rewarded. Last year it paid him £799,000.”
“Dr Clare Gerada, chairman of the Royal College of General Practitioners, said: ‘He cannot have any credibility when he is also heading a company with such huge interests in the very contracts his organisation is meant to police.”
See also Conflicts of Interest and NHS reform.
According to a tweet from James Ball
“Politics of the #NHSbill awful for lib dems: only 17% of their current supporters back it – and only 9% of their 2010 voters.”
Sounds plausible. Are you listening, Nick Clegg?
5 March 2012. The emergency motion for the Lib Dem Spring Conference (March 10 -11) has been published. See also the blog of the heroic Dr Charles West for more details. If Clegg manages to defeat this excellent motion, the last chance to save the NHS will be gone.
10 March 2012
Bitterly disappointed by vote at Lib Dem conference, not to debate the motion to drop the NHS bill. Who do I vote for now?
One thing that one can still do is to email all Lib Dem MPs give your views. Here is a list of their email addresses (via Lindy).
firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com,firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com
And here are email addresses for (most) Lib Dem peers)
firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com , firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org , email@example.com
13 March 2012. This is really last chance day. At 11 am, the Lords debate third reading of health bill and at 2 pm the Commons have emergency debate, triggered by the e-petition, which now has more than 173,000 signatures. I sent the following email to all Lib Dem peers and MPs this morning.
The idea that the changes to the health bill have solved its problems is simply wrong. Before you vote, please read http://abetternhs.wordpress.com/2012/03/11/40points/ ,
That is written by a working GP who knows what he’s talking about.
For the truth about the 49% disaster, read this.
There are 27 professional organisations who are against the bill (see here). Do you really understand the implications better than they do?
The vote at the lib dem conference gives you the mandate to vote according to your conscience. Please vote to drop the bill and start again.
I voted Lib Dem at every election from 2001. If you let us down on the health bill, I will certainly not do so again.
16 March 2012. I have learned ( from Lord Shutt) that there will be a 3-line whip on Lib Dem peers to vote against Lord Owen’s amendment. And this despite the vote against the Clegg-Williams motion at the Lib Dem conference last week. This makes the much vaunted party democracy look like a bit of a joke. The only hope now is the bishops. Here is a list of their email addresses. You can also contact them through Dr Éoin Clarke’s site (from where I got the addresses)
firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com
This is what I sent to them today.
You will be aware of the widespread concerns about the commercialisation of the NHS. No fewer than 27 medical organisations have now come out strongly against the bill and it’s clear that, despite (or because of?) over 1000 amendments, it is a real mess.
Despite the vote at the Lib Dems conference against the bill, I hear that there will be a 3-line whip in the Lords to force Lib Dem peers to vote against the very sensible proposal by Lord Owen to delay passing of the bill until the government release the assessment of the risks of passing it. This means that the Bishops will be crucial. I would like to ask you seriously to consider voting for Lord Owen’s motion on Monday. The future of the National Health Service lies in your hands
18 March 2012. Tomorrow is last hope for stopping the bill in the Lords. The 3-line whip will, I expect, ensure the defeat of Lord David Owen’s excellent amendment. The bill will probably become law. Two tweets express the impending death of the NHS quite poignantly. On 15 March @Heardin London wrote
"For a brief period during 20th century, people gave a fuck and looked after each other. Unfortunately this proved unprofitable."
and today, from @thewritertype,
"Years from now you’ll have to explain to children what the NHS was. Then you’ll have to explain what a LibDem was."
Poetry in 140 characters.
20 March 2012.
The hated bill was rammed through in the House of Commons, thanks to support from Lib Dems.
.The list of the peers and MPs who will make money out of privatisation is truly scary and deeply corrupt.
The Prince of Wales’ Foundation for Integrated Health shut down amidst scandal in April 2010. In July, we heard that a new “College of Medicine” was to arise from its ashes. It seemed clear from the people involved that the name “College of Medicine” would be deceptive.
Now the College of Medicine has materialised, and it is clear that one’s worst fears were well justified.
At first sight, it looks entirely plausible and well-meaning. Below the logo one reads
“There is a new force in medicine. A force that brings patients, doctors, nurses and other health professionals together, instead of separating them into tribes.”
"That force is the new College of Medicine. Uniquely, it brings doctors and other health professionals together with patients and scientists.”
It is apparent from the outset that the well-meaning words fall into the trap described so clearly by James May (see What ‘holistic’ really means). It fails to distinguish between curing and caring.
As always, the clue lies not in the words, but in the people who are running it.
Who is involved?
After a bit of digging on the web site, you find the names of the people on the Science Council of the “College of Medicine”, The preamble says
“Good medicine must be grounded in good science as well as compassion. The College’s Science Council brings a depth of knowledge from many senior figures.”
But then come the names. With the odd exception the “science council” is like a roll-call of quacks, the dregs left over from the Prince’s Foundation. The link (attached to each name) gives the College’s bio, My links tell a rather different story.
Professor George Lewith You’ll find plenty about George Lewith on this blog.
Professor Mustafa Djamgoz Superficially respectable but seduced by ‘ancient wisdom’ He once wrote to me "There are many ‘eastern’ remedies (such as acupuncture that we witnessed dismissed 25 year ago) that work. ". Well it isn’t as simple as that.
Professor Simon Gibbons A phytochemist with exaggerated ideas of what you can get from plants.
Professor Jane Plant A respectable geochemist who became obsessed with alternative medicine, Read about her here,
Dr Peter Fisher The Queen’s Homeopathic Physician. Advocate of the most discreded of all forms of quackery. Lots about him here.
Dr Michael Loughlin A post-modernist-influenced theorist who hates Ben Goldacre. Read about him here.
Dr Hugh MacPherson An acupuncturist and fellow traveller of the Prince of Wales. Read here.
Professor Andrew Miles I’m sorry to see him in this company after the good job he did in ejecting quacks at the University of Buckingham.
Simon Mills A man who thinks herbs can be classified as "hot"and "cold", See here and here
Professor Nicola Robinson Head of the Centre for Complementary Healthcare & Integrated Medicine,Thames Valley University A well known advocate of unevidenced treatments. Try Googling her
Dr Catherine Zollman Another hangover from the Princes’ Foundation, and believer in magic medicine
It seems that the "Scientific Council" of the College of Medicine could more properly be called an "Antiscientific Council".
There are a few gaps in this table, to be filled in soon. One can guarantee that a great deal more will appear about the College on the web, very soon.
The Governing Council of the College is equally replete with quacks (plus a few surprising names). It has on it, for example, a spiritual healer (Angie-Buxton King), a homeopath (Christine Glover), a herbalist (Michael McIntyre). Westminster University’s king of woo (David Peters), not to mention the infamous Karol Sikora. Buxton-King offers a remarkable service to heal people or animals at a distance.
Meanwhile, it seemed worthwhile to provide a warning that the title of the College is very deceptive. It hides an agenda that could do much harm.
It is, quite simply, the Prince of Wales by stealth.
28 October 2010
Professor Sir Graeme Catto, who has, disgracefully, allowed his name to be used as president of this “College” has said to me “There are real problems in knowing how to care for folk with chronic conditions and the extent of the evidence base for medicine is pretty limited”.
Yes of course that is quite true. There are many conditions for which medicine can still do little. There is a fascinating discussion to be had about how best to care for them. The answer to that is NOT to bring in spiritual healers and peddlers of sugar pills to deceive patients with their fairy stories. The “College of Medicine” will delay and pervert the sort of discussion that Catto says, rightly, is needed.
29 October 2010
I need a press card. I see that the BMJ also had a piece about the “College of Medicine” yesterday: Prince’s foundation metamorphoses into new College of Medicine, by Nigel Hawkes. He got the main point right there in the title.
As was clear since July, the driving force was Michael Dixon, Devon GP and ex medical director of the Prince’s Foundation. Hawkes goes easy on the homeopaths and spiritual healers, but did spot something that I can’t find on their web site. The “Faculties” will include
“in 2011, neuromusculoskeletal care. Two of the six strong faculty members for this specialty are from the British Chiropractic Association, which sued the author Simon Singh for libel for his disobliging remarks about the evidence base for their interventions.”
The College certainly picks its moment to endorse chiropractic, a subject that is in chaos and disgrace after they lost the Singh affair.
One bit of good news emerges from Hawkes’ piece, There is at least one high profile doubter in the medical establishment, Lord (John) Walton (his 2000 report on CAM was less than blunt, and has been widely misquoted by quacks) is reported as saying, at the opening ceremony
“I’m here as a sceptic, and I’ve just told my former houseman that,” he said. The target of the remark was Donald Irvine, another former GMC president and a member of the new college’s advisory council.”
31 October 2010. I got an email that pointed out a remarkable service offered by a member of College’s Governing Council. Angie Buxton-King, a “spiritual healer” employed by UCLH seems to have another web site, The Beacon of Healing Light that is not mentioned in her biography on the College’s site. Perhaps it should have been because it makes some remarkable claims. The page about distant healing is the most bizarre.
Absent Healing/Distant Healing
"Absent healing is available when it is not possible to visit the patient or it is not possible for the patient to be brought to our healing room. This form of healing has proved to be very successful for humans and animals alike."
"We keep a healing book within our healing room and every night spend time sending healing to all those who have asked for it. We have found that if a picture of the patient is sent to us the healing is more beneficial, we also require a weekly update to monitor any progress or change in the patients situation. Donations are welcome for this service."
I wonder what the Advertising Standards people make of the claim that it is “very successful”? I wonder what the president of the College makes of it? I’ve asked him.
Other blogs about the “College of Medicine”
30 October 2010. Margaret McCartney is always worth reading. As a GP she is at the forefront of medicine. She’s written about the College in The Crisis in Caring and dangerous inference. She’s also provided some information about a "professional member" of the College of Medicine, in ..and on Dr Sam Everington, at the Bromley by Bow Centre….
It is one of the more insulting things about alternative medicine addicts that they claim to be the guardians of caring (as opposed to curing), They are not, and people like McCartney and Michael Baum are excellent examples.
Prince of Wales to become honorary president of the “College of Medicine?”
Last night I heard a rumour that the Prince of Wales is, despite all the earlier denials, to become Honorary President of the “College”. If this is true, it completes the wholesale transformation of the late, unlamented, Prince’s Foundation for Integrated Medicine into this new “College”. Can anybody take it seriously now?
Text messages to Graeme Catto and Michael Dixon, inviting them to deny the rumour, have met with silence.
Herbal nonsense at the College
29 July 2011. I got an email from the College if Medicine [download it]. It contains a lot of fantasy about herbal medicines, sponsered by a company that manufactures them. It is dangeroous and corrupt.
Yesterday I was fired from the Conduct and Competence Committee of the CNHC. That is the organisation that was very quickly dubbed Ofquack in the blogosphere. So now I am free to write what I like about about it.
It has now become clear that voluntary self-regulation can not work. Recent events at the CNHC show how it has become a victim of its own rules [skip the background].
Background | Complaints | Why CNHC won’t work |
The CNHC was the product of the late unlamented Prince of Wales’ Foundation for Integrated Health. The Prince’s Foundation was paid a large amount of taxpayers’ money, £900,000, by the Department of Health to come up with a scheme for voluntary self-regulation of various sorts of alternative medicine.
There is, as usual, an enormous amount of relevant information can be found on the ebm-first site.
I posted a bit about Ofquack just before I joined them. There were two main points. One was to draw attention to the wonderful account of CNHC by Polly Toynbee, "Quackery and superstition – available soon on the NHS", The other was to point out an obvious problem with the job they were supposed to do.
“What won’t work is to insist that homeopaths are “properly trained”. If one takes the view that medicines that contain no medicine can’t work, then years of being trained to say that they do work, and years spent memorizing the early 19th century mumbo-jumbo of homeopathy, does not protect the public, it imperils them.”
On 25 September 2008, someone sent me an advertisement for a job on the conduct and competence committee. The job description seemed to fit me quite well, so I applied. I presumed they wouldn’t take me, and then I could write a blog about it. But after a phone interview with co-chair Maggy Wallace, I was amazed to be offered the job.
Since joining them I haven’t actually done anything whatsoever, apart from offering a few general ideas, because no cases have actually reached the Conduct and Competence Committee.
This was the first time I had encountered a quango at first hand. Several of the members seemed to have no great interest in medicine, or even in alternative medicine. They were more interested in regulation per se, or at least the sort of pseudo-regulation that most of these bodies mostly seem to offer. They seem to suffer from the well-known delusion that you can manage/regulate something without knowing anything about it. In cases such as this one, where what is being regulated is largely nonsense, there are bound to be problems.
There were two people, whom I did come to like particularly, Maggy Wallace and John Lant. They were both willing to talk and to listen.
The anonymous emails
The alternative medicine community took a surprisingly long time to notice my presence, but on 19 May 2010 a pretty vicious anonymous email arrived at the CNHC, complaining about me. Here it is.
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Thread-Topic: CNHC and Colquhoun
From: “Sara McGlouglan” <email@example.com>
Colquhoun and the CNHC
(Complementary and Natural Health Care Council)
What is the CNHC and why does it exist?
REFLEXOLOGY IS BOLLOCKS!
Nutritional therapy self-styled ‘nutritionists’; making untrue claims about diet in order to sell you unnecessary supplements.
Reiki: tea and sympathy, accompanied by arm-waving.
Shiatsu uh? It seems the teacher is already committed to placebo medicine.
[All the above quotes; and many more stated by David Colquhoun, CNHC Panel member]
1: Colquhoun and CNHC
2: More statements from Colquhoun
3: Want some more!!!
4: What to do
1. Colquhoun and CNHC
Colquhoun is a man who has steadfastly attacked, denigrated and taken all steps he can to undermine those involved in natural health. Yet Colquhoun is now (and has been for more than a year) a member of the CNHC’s Conduct and Competence Committee.
The role of CNHC is to regulate the professions of their members. But what is the rational behind allowing an avowed critic of natural medicine onto the Conduct and Competence Committee. Isn’t this like asking racist to be objective about the circumstances of racist crime?
Would you, as a practitioner having to answer to a complaint, be happy to have one of the panel members think your profession is ‘bollocks’ or that everything you practice is fraudulent from the start?
Latest moves from the government now aim at putting all Herbal Practitioners under the authority of CNHC.
Do you want your personal and confidential data, and that of your patient/client in the hands of Colquhoun? What might happen to it?
Certainly every practitioner has to be responsible for their actions and practice but since when has it been standard practice to weigh the scales against you rather than be assessed by a panel of independent peers?
2. More statements by Colquhoun ‘ nonsense, untrue, unnecessary, rectal obsession, mystic barmpot, fraud, theatrical placebo‘
In his "Patients’ guide to Magic medicine” [http://www.dcscience.net/?page_id=733]
Colquhoun summarizes many of the CNHC members’ professional activities (and other professions too) as follows:
* Reflexology: plain old foot massage, overlaid with utter nonsense about non-existent connections between your feet and your thyroid gland.
* Nutritional therapy: self-styled ‘nutritionists’ making untrue claims about diet in order to sell you unnecessary supplements.
* Spiritual healing: tea and sympathy, accompanied by arm-waving.
* Reiki: ditto.
* Angelic Reiki. The same but with added Angels, Ascended Masters and Galactic Healers. Excellent for advanced fantasists.
* Colonic irrigation: a rectal obsession that fails to rid you of toxins which you didn’t have in the first place.
* Anthroposophical medicine: followers of the mystic barmpot, Rudolf Steiner, for whom nothing whatsoever seems to strain credulity
* Alternative diagnosis: kinesiology, iridology, vega test etc, various forms of fraud, designed to sell you cures that don’t work; for problems you haven’t got.
* Homeopathy: giving patients medicines that contain no medicine whatsoever.
* Herbal medicine: giving patients an unknown dose of an ill-defined drug, of unknown effectiveness and unknown safety.
* Acupuncture: a rather theatrical placebo, with no real therapeutic benefit in most if not all cases.
So what kind of organisation is CNHC and why have they put him on to their Conduct and Competence panel? Being a CNHC member seems to be like inflicting pain on yourself.
CNHC also received funding from the Prince’s Foundation for Integrated Health (FIH). Yet Colquhoun regularly lambasts the FIH and Prince Charles himself categorizing him as a ‘champion of endarkenment’ [http://www.dcscience.net/?p=2544] and calling the FIH the Foundation Fellows of the Prince of Wales Foundation for Magic Medicine, an organisation that is at the forefront of spreading medical misinformation. [http://www.dcscience.net/?p=2131]
Of course, no one expects that because an organisation provides funding it should be exempt from criticism but surely, if you are working for an organisation whose purpose is to represent standards in a certain field, why would you have someone on your management team who fires out carping criticism at the supporting organisation, its practitioners and its practices unless perhaps, it is your purpose to spread discord and cut the funding.
No wonder the CNHC has problems. Their business plan (contingent on funding) was initially to have more than 10,000 enrolled members. This has been revised down to 2,000 and by all counts they have not even made this. Not surprising if the practitioners whom you represent don’t have any trust in the organisation that is supposed to represent the standards of your profession.
3. Want some more!!! fantasists, wrong and dangerous, largely quackery, lies, mumbo-jumbo, made-up fantasies, placebo medicine
On nutritional therapy
It is interesting to compare the high standards of the Nutrition Society with the quite different standards of BANT (the British Association for Applied Nutrition and Nutritional Therapy).& They bill themselves as the “Professional Body for Nutritional Therapists”. Nutritional therapists are those fantasists who believe you can cure any ill by buying some supplement pills. [http://www.dcscience.net/?p=1391]
[On quotes taken from Nutritional Therapy text] That must be about as close as you can get to claiming you can prevent cancer by taking vitamin pills. It is wrong and t is dangerous,
Sigh. What century are we living in? [http://www.dcscience.net/?p=555]
Everyone is for good nutrition of course, but ‘nutritional medicine’, or ‘nutritional therapy’ pretends to be able to cure all sorts of diseases by changes in diet or by buying expensive nutritional supplement pills. It has no perceptible relationship to the very important subjects of ‘nutrition’ or ‘dietetics’.. ‘Nutritional therapy’ is very firmly part of alternative medicine, in other words it is largely quackery. If you don’t believe that, read on. http://www.dcscience.net/?p=260
As usual, not many seemed to care very much about the secondary consequences of employing a ‘reflexologist’, namely that some poor kid has to memorise a bunch of lies to get the piece of paper demanded by HR (and the taxpayer has to fund it). http://www.dcscience.net/?page_id=237
What is the evidence about ‘spiritual healing’ ? Very little it seems.
No doubt, mumbo-jumbo can make some people feel better, and to that extent it is justified. But it can and should done be honestly (for example, foot massage is fine, ‘reflexology’ isn’t). Lies to patients should be minimised and universities should not be tempted to hand out certificates in mumbo jumbo. http://www.dcscience.net/?p=34
Michael McIntyre has the first of several long speeches, advocating more research. There was an advertisement for his web site “promotes best practice” (allegedly). He talks quite seriously about “reflexology” and so on, as though it were real subject (it isn’t; its “principles” are made-up fantasies). http://www.dcscience.net/?p=2813
Much of what they do at the Christie is straightforward massage, but they also promote the nonsensical principles of ‘reflexology’ and acupuncture. http://www.dcscience.net/?p=1466
The hilarious Radio 4 programme, The News Quiz had a good joke. Jeremy Hardy was asked which patients are hoping for a more robust constitution?. This referred to the £1m PR exercise mounted by the NHS to launch the NHS constitution. Hardy said that in the week when Barack Obama was inaugurated, and the word constitution have a whole different sort of gravitas in a week like that.
"I think the constitution should open with the words “We hold these truths to be self-evident REFLEXOLOGY IS BOLLOCKS" http://www.dcscience.net/?page_id=237
Shiatsu uh? It seems the teacher is already committed to placebo medicine. http://www.dcscience.net/?p=454
4. What to do
Why join an association that condones the above? Many have never joined CNHC because of this and other issues whilst existing CNHC members do not want to remain members.
1. Contact your professional association and insist that they do not join CNHC.
2. If your association is already a member then make a complaint and insist that your personal details are not supplied to CNHC.
3. There are other associations in existence that have the same purpose as CNHC. Find out about them. You (or your professional association) have the option to join them and
4. Please pass on this information to anyone else that you know. It is important that we are represented honestly and with integrity. The actions of CNHC do not add up.
Nobody seems to know the real name of Sara Glougan (aka Sam McGlougan. The letter is, I suppose, fair enough. I did say most of those things. What’s objectionable is that the anonymous writer seems to think that my opinions disqualify me from judging dispassionately a Conduct and Competence case. What this letter really says is that "we don’t want anyone who cares about the truth of claims to have any power over us". They just don’t want to be regulated in any effective way. The co-chair, Maggy Wallace, is a bit more sensible than that. The reason that I was appointed by her was because of my knowledge about how to assess evidence. But that isn’t a topic that interests alternative medicine advocates.
The fact of the matter is that the CNHC has been signing up people at a far slower rate than it hoped originally. It is in dire financial trouble (see, for example, Will the government bail out Ofquack?>, and CNHC’s report to the Department of Health in June 2009, obtained under the Freedom of Information Act.. The last thing they can afford is anything like this letter, which might reduce the registration rate still further. So it was inevitable that they had to get rid of me. Initially I was invited to resign on grounds of bad health. I didn’t, so on 10 August 2010 I was asked to appear before the board to be fired (in the nicest possible way). The CNHC now has nobody with any statistical expertise. Needless to say I’m not heartbroken about it. It was a waste of time for me, but it did provide a valuable insight into how voluntary self-regulation works, or rather fails to work.
The complaints against reflexologists
The CNHC has a complaints procedure, though its operation is somewhat tortuous.. As soon as they started to register reflexologists, several complaints were sent by the indefatigable Simon Perry (read his account)
“The ad suggests that reflexology is suitable for treating babies with colic, IBS and arthritis. She also claims to have experience in treating fertility issues. There is no reliable evidence to suggest that reflexology is capable of treating [these] issues.”
This complaint never came to to the Conduct and Competence Committee. It didn’t get past the preliminary Investigating Committee (chaired by John Lant), the job of which is to see if there is a case to answer. They decided that the advertisements in question did indeed breach paragraph 15 of the CNHC’s Code of Conduct, Performance and Ethics (see below). All 14 of Simon Perry’s complaints were upheld. However the Investigating Committee Panel’s report went on to say, apparently on the advice of the ‘Profession specific boards’ that
“The ICP found that the registrants’ Fitness to Practise was not impaired, because they did not deliberately seek to mislead their clients or to exaggerate the benefits of the therapy which they described in good faith. However they found that the registrants had made claims about the therapy offered which appeared to imply more efficacy than evidence necessarily provides.”
That, presumably, is why the complaints never reached the Conduct and Competence Committee. There was no case to answer.
One must admire Maggy Wallace’s statement that she “place on formal record their thanks to Simon Perry for bringing this matter to their attention.”. Never the less the problem is glaringly obvious and it shouldn’t have need a complaint.
Why ofquack can never work
The complaint episode is fascinating. The CNHC has clearly painted itself into a corner. It has brought to the fore all the contradictions that are inherent in what they are trying to do.
They have decided that reflexologists make false claims about what they can achieve.
But they decided it wasn’t the fault of the reflexologists because that is what they had been taught
Therefore the CNHC has judged that fitness of reflexologists to practise is not affected by the fact that they make false health claims.
That means that the CNHC judges that the public safety is not affected by whether their members make false health claims. That seems ludicrous enough, but it goes further
In the initial publicity it was often said that the job of the CNHC was safety -their job to protect the public, not to judge whether treatments worked or not. That sort of statement is contradicted directly by paragraph 15 of their Code of Conduct, Performance and Ethics, which reads thus.
15. You must follow CNHC guidelines in relation to advertising your services
Any advertising you undertake in relation to your professional activities must be accurate. Advertisements must not be misleading, false, unfair or exaggerated. You must not claim that your personal skills, equipment or facilities are better than anyone else’s.
If you are involved in advertising or promoting any other product or service, you must make sure that you use your knowledge, healthcare skills, qualifications and experience in an accurate and professionally responsible way. You must not make or support unjustifiable statements relating to particular products or services. Any potential financial rewards to you should be made explicit and play no part at all in your advice or recommendations of products and services that you give to patients, clients and users.
This paragraph places on the CNHC the responsibility for judging whether or not a treatment does what’s claimed for it. With my departure, there is really nobody left who is well-qualified to do that,
but nonetheless, their judgement on claims made by reflexologists was quite right.
The assertion by the CNHC that the false claims were OK because that is what reflexologists are taught is a direct admission that the courses that ‘train’ reflexologists are teaching them to say things that are not true. Of course the rest of the world knew that already, but to have it admitted by the CNHC is amazing.
Part of the job of the CNHC is to judge whether registrants are properly trained. But they have just decided that courses for reflexologists teach them to say things that aren’t true, That leaves the CNHC it an impossible position. By accepting reflexologists, they are saying that it doesn’t really matter that they are taught to make false claims, The criteria for entry include
“Have undertaken a programme of education and training which meets, as a minimum, the National Occupational Standards for that profession/discipline”
This shifts the responsibility for deciding what’s acceptable to National Occupational Standards and Skills for Health. Neither of these quangos is in the least concerned about what’s true and what isn’t. That’s not surprising when you realise who drafted all the HR style nonsense to be found at Skills for Health? None other than the late Prince of Wales’ Foundation. The stuff produced by them isn’t worth the paper it’s written on. There is something about Skills for Health in the post where I recount a phone call with them, When I asked whether they would produce standards for talking to trees, I was referred, in all seriousness, to LANTRA, the Land based skills council. You couldn’t make it up.
The National Occupational Standards (NOS) directory leads to the NOS for reflexology. The preamble says
Reflexology is the study and practice of treating reflex points and areas in the feet and hands that relate to corresponding parts of the body. Using precise hand and finger techniques a reflexologist can improve circulation, induce relaxation and enable homeostasis. These three outcomes can activate the body’s own healing systems to heal and prevent ill health.
There is, if course, not a shred of reason to think that “areas in the feet and hands that relate to corresponding parts of the body”. This statement alone would fail the CNHC’s code of conduct. National Occupational Standards in this area are simply a farce.
What will the CNHC do about these paradoxes? The complaint report said
“The ICP have asked Maggie Dunn, the CNHC Registrar, to initiate, as a matter of priority, discussions with the CNHC’s Profession Specific Boards and the Professional Fora to agree advice to registrants in relation to paragraph 15.”
I was told that this might take between 3 and 5 years to do. But I have a strong feeling that it will never be done in any effective way. If the CNHC prevented training courses from teaching students to make claims that aren’t justified by evidence, just about every course would close and the CNHC would crumble to dust. The result would be the ultimate irony. Alternative medicine would be abolished, not by skeptics, but by the CNHC.
That follows inevitably from the complaint judgement combined with paragraph 15 of the code of conduct.
It will be fascinating to see how the CNHC tries to escape from the grave that it has dug for itself.
If the CNHC implements properly its own code of conduct, few people will sign up and CNHC will die. If it fails to implement its own code of conduct it would be shown to be a dishonest sham.
Interview for Pod Delusion on the CNHC case
Hot off the press
The Prince’s Foundation for Integrated Health (FIH) has been spreading misinformation about medicine since 1993. It has featured often on this blog.
Now it has closed its doors.
An announcement has appeared on the FIH website
30 April 2010
The Trustees of The Prince’s Foundation for Integrated Health have decided to close the charity.
The announcement goes on
"Whilst the closure has been planned for many months and is part of an agreed strategy, the Trustees have brought forward the closure timetable as a result of a fraud investigation at the charity."
"The Trustees feel that The Foundation has achieved its key objective of promoting the use of integrated health. Since The Foundation was set up in 1993, integrated health has become part of the mainstream healthcare agenda, with over half a million patients using complementary therapies each year, alongside conventional medicine. . . "
While the immediate precipitating cause may have been the fraud (see below), the idea that the Foundation "has achieved its key objective of promoting the use of integrated health" seems like a ludicrous bit of make-believe. Well, make-believe is something with which the Foundation was quite familiar. At a time when university courses in quackery are vanishing like the snow in springtime, they can hardly believe that their aims have been achieved. But I guess one could not expect them to say "sorry folks, we were wrong all along".
The 2010 Conference is cancelled too
Judging by the quality of the 2009 conference, which I analysed at length last year, the cancellation of the 2010 conference is very welcome news (except perhaps to a few sycophants looking for honours).
What next? A College?
The rumour is that a “College of Integrated Medicine” may arise from the ashes of FIH. Or even, heaven forbid. a Royal College of Integrated baloney. Since universities seem to be deciding that it isn’t sensible to teach myth as truth, i is not unlikely.
“Prince Charles’s aide at homeopathy charity arrested on suspicion of fraud“
This headline, of an article in the Guardian, by Robert Booth, was not entirely unexpected.
The parlous state of the accounts at the Prince’s Foundation for Integrated Health has been documented already at
“An aide in Prince Charles’s campaign for wider use of complementary medicine in the NHS was arrested at dawn today on suspicion of fraud and money-laundering at the prince’s health charity.
A 49-year old man, understood to be a former senior official at the Prince’s Foundation for Integrated Health, was taken into custody at a police station in north London. He was arrested alongside a 54-year-old woman, who was being held at the same address.
The arrests follow a police investigation into £300,000 unaccounted for in the books of the charity, of which the Prince is president.”
More news will appear here, as it comes in.
Other posts on this topic appeared rapidly.
The Guardian 30 April. Robert Booth Prince of Wales’s health charity wound up in wake of fraud investigation
Dr Aust’s Spleen 30 April In memoriam. In which Dr Aust gets a bit poetic
Quackometer 30 April. Prince’s Foundation for Integrated Health Closes. Prince Charles’ Toad Eaters are no more.
Followed by the rest of the mainstream media.
Edzard Ernst 1 May 2010, in the Indepenndent. Better than any journalist. Why alternative medicine wins from the foundation’s demise. Read it! Here are some quotations.
“I therefore think that the FIH has become a lobby group for unproven and disproven treatments populated by sycophants.”
“The FIH has repeatedly been economical with the truth. For instance when it published a DoH-sponsored patient guide that was devoid of evidence. They claimed evidence was never meant to be included. But I had seen a draft where it was and friends have seen the contract with the DoH where “evidence” was an important element. “
“I hope that, after the demise of FIH, the discussion about alternative medicine in the UK can once more become rational. I also hope that Prince Charles has the greatness of selecting advisers who actually advise rather than “Yes Men” who are hoping to see their names on the next Honours List. “
1 May 2010. According to Martin Delgado, in the Daily Mail, the people who were arrested on suspicion of fraud were accountant George Gray and his wife. Gray was Finance Director and acting Chief Executive of FIH. About as senior as you can get.
Gray spent two weeks (two weeks?) at Diabetes UK in 2004 before becoming finance director at the Leadership Foundation For Higher Education.
This post recounts a complicated story that started in January 2009, but has recently come to what looks like a happy ending. The story involves over a year’s writing of letters and meetings, but for those not interested in the details, I’ll start with a synopsis.
Synopsis of the synopsis
In January 2009, a course in "integrated medicine" was announced that, it was said, would be accredited by the University of Buckingham. The course was to be led by Drs Rosy Daniel and Mark Atkinson. So I sent an assessment of Rosy Daniel’s claims to "heal" cancer to Buckingham’s VC (president), Terence Kealey, After meeting Karol Sikora and Rosy Daniel, I sent an analysis of the course tutors to Kealey who promptly demoted Daniel, and put Prof Andrew Miles in charge of the course. The course went ahead in September 2009. Despite Miles’ efforts, the content was found to be altogether too alternative. The University of Buckingham has now terminated its contract with the "Faculty of Integrated Medicine", and the course will close. Well done.Buckingham.
- January 2009. I saw an announcement of a Diploma in Integrated Medicine, to be accredited by the University of Buckingham (UB). The course was to be run by Drs Rosy Daniel and Mark Atkinson of the College of Integrated Medicine, under the nominal directorship of Karol Sikora (UB’s Dean of Medicine). I wrote to Buckingham’s vice-chancellor (president), Terence Kealey, and attached a reprint of Ernst’s paper on carctol, a herbal cancer ‘remedy’ favoured by Daniiel.
- Unlike most vice-chancellors, Kealey replied at once and asked me to meet Sikora and Daniel. I met first Sikora alone, and then, on March 19 2009, both together. Rosy Daniel gave me a complete list of the speakers she’d chosen. Most were well-known alternative people, some, in my view, the worst sort of quack. After discovering who was to teach on the proposed course, I wrote a long document about the proposed speakers and sent it to the vice-chancellor of the University of Buckingham, Terence Kealey on March 23rd 2009.. Unlike most VCs, he took it seriously. At the end of this meeting I asked Sikora, who was in nominal charge of the course, how many of the proposed tutors he’d heard of. The answer was "none of them"
- Shortly before this meeting, I submitted a complaint to Trading Standards about Rosy Daniel’s commercial site, HealthCreation, for what seemed to me to be breaches of the Cancer Act 1939, by claims made for Carctol. Read the complaint.
- On 27th April 2009, I heard from Kealey that he’d demoted Rosy Daniel from being in charge of the Diploma and appointed Andrew Miles, who had recently been appointed as Buckingham’s Professor of Public Health Education and Policy &Associate Dean of Medicine (Public Health). Terence Kealey said "You’ve done us a good turn, and I’m grateful". Much appreciated. Miles said the course “needs in my view a fundamental reform of content. . . “
- Although Rosy Daniel had been demoted, she was still in charge of delivering the course at what had, by this time, changed its name to the Faculty of Integrated Medicine which, despite its name, is not part of the university.
- Throughout the summer I met Miles (of whom more below) several times and exchanged countless emails, but still didn’t get the revised list of speakers. The course went ahead on 30 September 2009. He also talked with Michael Baum and Edzard Ernst.
- By January 2010, Miles came to accept that the course was too high on quackery to be a credit to the university, and simply fired The Faculty of Integrated Medicine. Their contract was not renewed. Inspection of the speakers, even after revision of the course, shows why.
- As a consequence, it is rumoured that Daniel is trying to sell the course to someone else. The University of Middlesex, and unbelievably, the University of Bristol, have been mentioned, as well as Thames Valley University, the University of Westminster, the University of Southampton and the University of East London. Will the VCs of these institutions not learn something from Buckingham’s experience? It is to be hoped that they would at the very least approach Buckingham to ask pertinent questions? But perhaps a more likely contender for an organisation with sufficient gullibility is the Prince of Wales newly announced College of Integrated Medicine. [but see stop press]
The details of the story
The University of Buckingham (UB) is the only private university in the UK. Recently it announced its intention to start a school of medicine (the undergraduate component is due to start in September 2011). The dean of the new school is Karol Sikora.
Karol Sikora shot to fame after he appeared in a commercial in the USA. The TV commercial was sponsored by a far-right Republican campaign group, “Conservatives for Patients’ Rights” It designed to prevent the election of Barack Obama, by pouring scorn on the National Health Serrvice. A very curious performance. Very curious indeed. And then there was a bit of disagreement about the titles that he claimed to have.
As well as being dean of medicine at UB. Karol Sikora is also medical research director of CancerPartnersUK. a private cancer treatment company. He must be a very busy man.
Karol Sikora’s attitude to quackery is a mystery wrapped in an enigma. As well as being a regular oncologist, he is also a Foundation Fellow of that well known source of unreliable information, The Prince of Wales Foundation for Integrated Health. He spoke at their 2009 conference.
In the light of that, perhaps it is not, after all, so surprising thet the first action of UB’s medical school was to accredit a course a Diploma in Integrated Medicine. This course has been through two incarnations. The first prospectus (created 21 January 2009) advertised the course as being run by the British College of Integrated Medicine.But by the time that UB issued a press release in July 2009, the accredited outfit had changed its name to the Faculty of Integrated Medicine That grand title makes it sound like part of a university. It isn’t.
Rosy Daniel runs a company, Health Creation which, among other things, recommended a herbal concoction. Carctol. to "heal" cancer, . I wrote to Buckingham’s vice-chancellor (president), Terence Kealey, and attached a reprint of Ernst’s paper on Carctol. . Unlike most university vice-chancellors, he took it seriously. He asked me to meet Karol Sikora and Rosy Daniel to discuss it. After discovering who was teaching on this course, I wrote a document about their backgrounds and sent it to Terence Kealey. The outcome was that he removed Rosy Daniel as course director and appointed in her place Andrew Miles, with a brief to reorganise the course. A new prospectus, dated 4 September 2009, appeared. The course is not changed as much as I’d have hoped, although Miles assures me that while the lecture titles themselves may not have changed, he had ordered fundamental revisions to the teaching content and the teaching emphases.
In the new prospectus the British College of Integrated Medicine has been renamed as the Faculty of Integrated Medicine, but it appears to be otherwise unchanged. That’s a smart bit of PR. The word : “Faculty” makes it sound as though the college is part of a university. It isn’t. The "Faculty" occupies some space in the Apthorp Centre in Bath, which houses, among other things, Chiropract, Craniopathy (!) and a holistic vet,
The prospectus now starts thus.
The Advisory Board consists largely of well-know advocates of alternative medicine (more information about them below).
Most of these advisory board members are the usual promoters of magic medicine. But three of them seem quite surprising,Stafford Lightman, Nigel Sparrow and Nigel Mathers.
Stafford Lightman? Well actually I mentioned to him in April that his name was there and he asked for it to be removed, on the grounds that he’d had nothing to do with the course. It wasn’t removed for quite a while, but the current advisory board has none of these people. Nigel Sparrow and Nigel Mathers, as well as Lightman, sent letters of formal complaint to Miles and Terence Kealey, the VC of Buckingham, to complain that their involvement in Rosy Daniel’s set-up had been fundamentally misrepresented by Daniel. With these good scientists having extricated themselves from Daniel’s organisation, the FIM has only people who are firmly in the alternative camp (or quackery, as i’d prefer to call it). For example, people like Andrew Weil and George Lewith.
Andrew Weil, for example, while giving his address as the University of Arizona, is primarily a supplement salesman. He was recently reprimanded by the US Food and Drugs Administration
“Advertising on the site, the agencies said in the Oct. 15 letter, says “Dr. Weil’s Immune Support Formula can help maintain a strong defense against the flu” and claims it has “demonstrated both antiviral and immune-boosting effects in scientific investigation.”
The claims are not true, the letter said, noting the “product has not been approved, cleared, or otherwise authorized by FDA for use in the diagnosis, mitigation, prevention, treatment, or cure of the H1N1 flu virus.”
This isn’t the first time I’ve come across people’s names being used to support alternative medicine without the consent of the alleged supporter. There was, for example, the strange case of Dr John Marks and Patrick Holford.
Misrepresentation of this nature seems to be the order of the day. Could it be that people like Rosy Daniel are so insecure or, indeed, so unimportant within the Academy in real terms (where is there evidence of her objective scholarly or clinical stature?), that they seek to attach themselves, rather like limpets to fishing boats, to people of real stature and reputation, in order to boost their own or others’ view of themselves by a manner of proxy?
When the course was originally proposed, a brochure appeared. It said accreditation by the University of Buckingham was expected soon.
Not much detail appeared in the brochure, Fine words are easy to write but what matters is who is doing th teaching. So I wrote to the vice-chancellor of Buckingham, Terence Kealey. I attached a reprint of Ernst’s paper on carctol, a herbal cancer ‘remedy’ favoured by Daniel (download the cached version of her claims, now deleted).
Kealey is regarded in much of academia as a far-right maverick, because he advocates ideas such as science research should get no public funding,and that universities should charge full whack for student fees. He has, in fact, publicly welcomed the horrific cuts being imposed on the Academy by Lord Mandelson. His piece in The Times started
“Wonderful news. The Government yesterday cut half a billion pounds from the money it gives to universities”
though the first comment on it starts
"Considerable accomplishment: to pack all these logical fallacies and bad metaphors in only 400 words"
He and I are probably at opposite ends of the political spectrum. Yet he is the only VC who has been willing to talk about questions like this. Normally letters to vice-chancellors about junk degrees go unanswered. Not so with Kealey. I may disagree with a lot of his ideas, but he is certainly someone you can do business with.
Kealey responded quickly to my letter, sent in January 2009, pointing out that Rosy Daniel’s claims about Carctol could not be supported and were possibly illegal. He asked me to meet Sikora and Daniel. I met first Sikora alone, and then, on March 19 2009, both together. Rosy Daniel gave me a complete list of the speakers she’d chosen to teach on this new Diploma on IM.
After discovering who was to teach on the proposed course, I wrote a long document about the proposed speakers and sent it to Terence Kealey on March 23rd 2009. It contained many names that will be familiar to anyone who has taken an interest in crackpot medicine, combined with a surprisingly large element of vested financial interests. Unlike most VCs, Kealey took it seriously.
The remarkable thing about this meeting was that I asked Sikora how many names where familiar to him on the list of people who had been chosen by Rosy Daniel to teach on the course. His answer was "none of them". Since his name and picture feature in all the course descriptions, this seemed like dereliction of duty to me.
After seeing my analysis of the speakers, Terence Kealey reacted with admirable speed. He withdrew the original brochure, demoted Rosy Daniel (in principle anyway) and brought in Prof Andrew Miles to take responsibility for the course. This meant that he had to investigate the multiple conflicts of interests of the various speakers and to establish some sort of way forward in the ‘mess’ of what had been agreed before Miles’ appointment to Buckingham
Miles is an interesting character, a postdoctoral neuroendocrinologist, turned public health scientist. I’d come across him before as editor-in-chief of the Journal of Evaluation in Clinical Practice This is a curious journal that is devoted mainly to condemning Evidence Based Medicine. Much of its content seems to be in a style that I can only describe as post-modernist-influenced libertarian.
The argument turns on what you mean by ‘evidence’ and, in my opinion, Miles underestimates greatly the crucial problem of causality, a problem that can be solved only by randomisation, His recent views on the topic can be read here.
An article in Miles’ journal gives its flavour: "Andrew Miles, Michael Loughlin and Andreas Polychronis, Medicine and evidence: knowledge and action in clinical practice". Journal of Evaluation in Clinical Practice 2007, 13, 481–503 [download pdf]. This paper launches an attack on Ben Goldacre, in the following passage.
“Loughlin identifies Goldacre  as a particularly luminous example of a commentator who is able not only to combine audacity with outrage, but who in a very real way succeeds in manufacturing a sense of having been personally offended by the article in question. Such moralistic posturing acts as a defence mechanism to protect cherished assumptions from rational scrutiny and indeed to enable adherents to appropriate the ‘moral high ground’, as well as the language of ‘reason’ and ‘science’ as the exclusive property of their own favoured approaches. Loughlin brings out the Orwellian nature of this manoeuvre and identifies a significant implication.”
"If Goldacre and others really are engaged in posturing then their primary offence, at least according to the Sartrean perspective adopted by Murray et al. is not primarily intellectual, but rather it is moral. Far from there being a moral requirement to ‘bend a knee’ at the EBM altar, to do so is to violate one’s primary duty as an autonomous being.”
This attack on one of my heroes was occasioned because he featured one of the most absurd pieces of post-modernist bollocks ever, in his Guardian column in 2006. I had a go at the same paper on this blog, as well as an earlier one by Christine Barry, along the same lines. There was some hilarious follow-up on badscience.net. After this, it is understandable that I had not conceived a high opinion of Andrew Miles. I feared that Kealey might have been jumping out of the frying pan into the fire.
After closer acquaintance I have changed my mind, In the present saga Andrew Miles has done an excellent job. He started of sending me links to heaven knows how many papers on medical epistemology, to Papal Encyclicals on the proposed relationship between Faith and Reason and on more than one occasion articles from the Catholic Herald (yes, I did read it). This is not entirely surprising, as Miles is a Catholic priest as well as a public health academic, so has two axes to grind. But after six months of talking, he now sends me links to junk science sites of the sort that I might get from, ahem, Ben Goldacre.
Teachers on the course
Despite Andrew Miles best efforts, he came in too late to prevent much of the teaching being done in the parallel universe of alternative medicine, The University of Buckingham had a pre-Miles, legally-binding contract (now terminated) with the Faculty of Integrated Medicine, and the latter is run by Dr Rosy Daniel and Dr Mark Atkinson. Let’s take a look at their record.
Rosy Daniel BSc, MBBCh
Dr Rosy Daniel first came to my attention through her commercial web site, Health Creation. This site, among other things, promoted an untested herbal concoction, Carctol, for "healing" cancer.
Carctol: Profit before Patients? is a review by Edzard Ernst of the literature, such as it is, and concludes
Carctol and the media hype surrounding it must have given many cancer patients hope. The question is whether this is a good or a bad thing. On the one hand, all good clinicians should inspire their patients with hope . On the other hand, giving hope on false pretences is cruel and unethical. Rosy Daniel rightly points out that all science begins with observations . But all science then swiftly moves on and tests hypotheses. In the case of Carctol, over 20 years of experience in India and almost one decade of experience in the UK should be ample time to do this. Yet, we still have no data. Even the small number of apparently spectacular cases observed by Dr. Daniel have not been published in the medical literature.
On this basis I referred Health Creation to Trading Standards officer for a prima facie breach of the Cancer Act 1939. ]Download the complaint document]. Although no prosecution was brought by Trading Standards, they did request changes in the claims that were being made. Here is an example.
A Google search of the Health Creation site for “Carctol” gives a link
Dr Daniel has prescribed Carctol for years and now feels she is seeing a breakthrough. Dr Daniel now wants scientists to research the new herbal medicine
But going to the link produces
You are not authorized to access this page.
You can download the cached version of this page, which shows the sort of claims that were being made before Trading Standards Officers stepped in. There are now only a few oblique references to Carctol on the Health Creation site, e.g. here..
Both Rosy Daniel and Karol Sikora were speakers at the 2009 Princes’s Foundation Conference, in some odd company.
Mark Atkinson MBBS BSc (Hons) FRIPH
Dr Mark Atkinson is co-leader of the FiM course. He is also a supplement salesman, and he has promoted the Q-link pendant. The Q-link pendant is a simple and obvious fraud designed to exploit paranoia about WiFi killing you. When Ben Goldacre bought one and opened it. He found
“No microchip. A coil connected to nothing. And a zero-ohm resistor, which costs half a penny, and is connected to nothing.”
Nevertheless, Mark Atkinson has waxed lyrical about this component-free device.
“As someone who used to get tired sitting in front of computers and used to worry about the detrimental effects of external EMF’s, particularly as an avid user of mobile phones, I decided to research the various devices and technologies on the market that claim to strengthen the body’s subtle energy fields. It was Q Link that came out top. As a Q link wearer, I no longer get tired whilst at my computer, plus I’m enjoying noticeably higher energy levels and improved mental performance as a result of wearing my Q Link. I highly recommend it.” Dr Mark Atkinson, Holistic Medical Physician
Mark Atkinson is also a fan of Emo-trance. He wrote, In Now Magazine,
"I wanted you to know that of all the therapies I’ve trained in and approaches that I have used (and there’s been a lot) none have excited me and touched me so deeply than Emotrance."
"Silvia Hartmann’s technique is based on focusing your thoughts on parts of your body and guiding energy. It can be used for everything from insomnia to stress. The good news is that EmoTrance shows you how to free yourself from these stuck emotions and release the considerable amounts of energy that are lost to them."
Aha so this particular form of psychobabble is the invention of Silvia Hartmann. Silvia Hartmann came to my attention because her works feature heavily in on of the University of Westminster’s barmier “BSc” degrees, in ‘naturopaths’, described here. She is fanous, apart from Emo-trance, for her book Magic, Spells and Potions
“Dr Hartmann has created techniques that will finally make magic work for you in ways you never believed to be possible.”
Times Higher Education printed a piece with the title ‘Energy therapy’ project in school denounced as ‘psychobabble’. They’d phoned me a couple of days earlier to see whether I had an opinion about “Emotrance”. As it happens, I knew a bit about it because it had cropped up in a course given at, guess where, the University of Westminster . It seems that a secondary school had bought this extreme form of psychobabble. The comments on the Times Higher piece were unusually long and interesting.
It turned out that the inventor of “Emotrance”, Dr Silvia Hartmann PhD., not only wrote books about magic spells and potions, but also that her much vaunted doctorate had been bought from the Universal Life Church, current cost $29.99.
The rest of the teachers
The rest of the teachers on the course, despite valiant attempts at vetting by Andrew Miles, includes many names only too well-known to anybody who has taken and interest in pseudo-scientific medicine. Here are some of them.
Damien Downing:, even the Daily Mail sees through him. Enough said.
Kim Jobst, homoepath and endorser of the obviously fraudulent Q-link
pendant. His Plaxo profile says
About Kim A. Jobst
Consultant, Wholystic Care Physician [sic!] , Medical Homoeopath, Specialist in Neurodegeneration and Dementia, using food state nutrition, diet and lifestyle to facilitate Healing and Growth;
Catherine Zollman, Well known ally of HRH and purveyer of woo.
Harald Walach, another homeopath, fond of talking nonsense about "quantum effects".
Nicola Hembry, a make-believe nutritionist and advocate of vitamin C and laetrile for cancer
Simon Mills, a herbalist who is inclined to diagnoses like “hot damp”, ro be treated with herbs that tend to “cool and dry.”
David Peters, of the University of Westminster. Enough said.
Nicola Robinson of Thames Valley University. Advocate of unevidenced treatmsnts.
Michael Dixon, of whom more here.
And last but not least,
The University of Buckingham removes accreditation of the Faculty of Integrated Medicine
The correspondence has been long and, at times, quite blunt. Here are a few quotations from it, The University of Buckingham, being private, is exempt from the Freedom of Information Act (2000) but nevertheless they have allowed me to reproduce the whole of the correspondence. The University, through its VC, Terence Keeley, has been far more open than places that are in principle subject to FOIA, but which, in practice, always try to conceal material. I may post the lot, as time permits, but meanwhile here are some extracts. They make uncomfortable reading for advocates of magic medicine.
Miles to Daniel, 8 Dec 2009
” . . . now that the University has taken his [Sikora’s] initial advice in trialing the DipSIM and has found it cost-ineffective, the way forward is therefore to alter that equation through more realistic financial contribution from IHT/FIM at Bath or to view the DipSIM as an experiment that has failed and which must give way to other more viable initiatives."
"The University is also able to confirm that we hold no interest in jointly developing any higher degrees on the study of IM with IHT/FIM at Bath. This is primarily because we are developing our own Master’s degree in Medicine of the Person in collaboration with various leading international societies and scholars including the WHO and which is based on a different school of thought. "
Miles to Daniel 15 Dec 2009
It appears that you have not fully assimilated the content of my earlier e-mails and so I will reiterate the points I have already made to you and add to them.
The DipSIM is an external activity – in fact, it is an external collaboration and nothing more. It is not an internal activity and neither is it in any way part of the medical school and neither will it become so and so the ‘normal rules’ of academic engagement and scholarly interchange do not apply. Your status is one of external collaborator and not one of internal or even visiting academic colleague. There is no “joint pursuit” of an academically rigorous study of IM by UB and IHT/FIM beyond the DipSIM and there are no plans, and never have been, for the “joint definition of research priorities” in IM. The DipSIM has been instituted on a trial basis and this has so far shown the DipSIM to be profoundly cost-ineffective for the University. You appear to misunderstand this – deliberately or otherwise."
Daniel to Miles 13 Jan 2010
"However, I am aware that weather permitting you and Karol will be off to the Fellows meeting for the newly forming National College (for which role I nominated you to Dr Michael Dixon and Prof David Peters.)
I have been in dialogue with Michael and Boo Armstrong from FIH and they are strongly in favour of forming a partnership with FIM so that we effectively become one of many new faculties within the College (which is why we change our name to FIM some months ago).
I have told Michael about the difficulties we are having and he sincerely hopes that we can resolve them so that we can all move forward as one. "
Miles to Daniel 20 Jan 2010
"Congratulations on the likely integration of your organisation into the new College of Integrative Health which will develop out of the Prince’s Foundation for Integrated Health. This
will make an entirely appropriate home for you for the longer term.
Your image of David Colquhoun "alive and kicking" as the Inquisitor General, radiating old persecutory energy and believing "priestess healers" (such as you describe youself) to be best "tortured, drowned and even burnt alive", will remain with me, I suspect, for many years to come (!). But then, as the Inquisitor General did say, ‘better to burn in this life than in the next’ (!). Overall, then, I reject your conclusion on the nature of the basis of my decision making and playfully suggest that it might form part of the next edition of Frankfurt’s recent volume ["On Bullshit] http://press.princeton.edu/titles/7929.html I hope you will forgive my injection of a little academic humour in an otherwise formal and entirely serious communication.
The nature of IM, with its foundational philosophy so vigorously opposed by mainstream medicine and the conitnuing national and international controversies which engulf homeopaths, acupuncturists, herbalists, naturopaths, transcendental meditators, therapeutic touchers, massagers, reflexologists, chiropractors, hypnotists, crystal users, yoga practitioners, aromatherapists, energy channelers, chinese medicine practitioners et al, can only bring the University difficulties as we seek to establish a formal and internationally recognised School of Medicine and School of Nursing.
I do not believe my comments in relation to governance at Bath are "offensive". They are, on the contrary, entirely accurate and of concern to the University. There have been resignations at senior level from your Board due to misrepresentation of your position and there has been a Trading Standards Authority investigation into further instances of misrepresentation. I am advised that an audit is underway of your compliance with the Authority’s instructions. You have therefore not dealt with my concerns, you have merely described them as "offensive".
I note from your e-mail that you are now in discussions with other universities and given the specific concerns of the University of Buckingham which I have dealt with exhaustively in this and other correspondences and the incompatibility of the developments at UB with the DipSIM and your own personal ambitions, etc., I believe you to have taken a very wise course and I wish you well in your negotiations. In these circumstances I feel it appropriate to enhance those negotiations by confirming that the University of Buckingham will not authorise the intake of a second cohort of students and that the relationship between IHT and the University will cease following the graduation of those members of the current course that are successful in their studies – the end of February 2011."
From Miles 2 Feb 2010
"Here is the list of teachers – you can subtract me (I withdrew from teaching when the antics ay Bath started) and also Professor John Cox (Former President of The Royal College of Psychiatrists and Former Secretary General of the World Psychiatric Association) who withdrew when he learned of some of the stuff going on…. Karol Sikora continues to teach. Michael Loughlin and Carmel Martin are both good colleagues of mine and, I can assure you – taught the students solid stuff! Michael taught medical epistemology and Carmel the emerging field of systems complexity in health services (Both of them have now withdrawn from teaching commitments).
The tutors shown are described by Rosy as the finest minds in IM teaching in the country. I interviewed tham all personally on (a) the basis of an updated CV & (b) via a 30 min telephone interview with me personally. Some were excluded from teaching because they were not qualified to do so academically (e.g. Boo Armstrong, Richard Falmer, not even a first degree, etc, etc., but gave a short presentation in a session presided over by an approved teacher) and others were approved because of their academic qualifications, PhD, MD, FRCP etc etc etc) and activity within the IM field. Each approved teacher was issued with highly specific teaching guidance form me (no bias, reference to opposing schools of thought, etc etc) and each teacher was required to complete and sign a Conflicts of Interest form. All of these documentations are with me here. Short of all this governance it’s impossible to bar them from teaching because who else would then do it?! Anyway, the end is in sight – Hallelujah! "
From Miles 19 Feb 2010
Just got back to the office after an excellent planning meeting for the new Master’s Degree in Person-centred Medicine and a hearty (+ alcoholic) lunch at the Ath! Since I shall never be a FRS, the Ath seems to me the next best ‘club’ (!). Michael Baum is part of the steering committee and you might like to take his thoughts on the direction of the programme. Our plans may even find their way into your Blog as an example of how to do things (vs how not to do things, i.e. CAM, IM, etc!). This new degree will sit well alongside the new degrees in Public Health – i.e. the population/utilitarian outlook of PH versus the individual person-centred approach., etc. "
And an email from a senior UB spokesperson
"Rumour has it that now that Buckingham has dismissed the ‘priestess healer of Bath’, RD [Rosy Daniel] , explorations are taking place with other universities, most of which are subject to FoI request from DC at the time of writing. Will these institutions have to make the same mistakes Buckingham did before taking the same action? Rumour also has it that RD changed the name of her institution to FIM in order to fit neatly into the Prince’s FIH, a way, no doubt, of achieving ‘protection’ and ‘accreditation’ in parallel with particularly lucrative IM ‘education’ (At £9,000 a student and with RD’s initial course attracting 20 mainly GPs, that’s £180,00 – not bad business…. And Buckingham’s ‘share of this? £12,000!”
The final bombshell; even the Prince of Wales’ FIH rejects Daniel and Atkinson?
Only today (31 March) I was sent, from a source that I can’t reveal, an email which comes from someone who "represent the College and FIH . . . ".. This makes it clear that the letter comes from the Prince of Wales’ Foundation for Integrated Health
Dr Rosy Daniel BSc MBBCh
Director of the Faculty of Integrated Medicine
Medical Director Health Creation
30th March 2010
RE: Your discussion paper and recent correspondence
Thank you for meeting with [XXXXXX] and myself this evening to discuss your proposals concerning a future relationship between your Faculty of Integrated Medicine and the new College. As you know, he and I have been asked to represent the College and FIH in this matter.
We are aware of difficulties facing your organisations and the FIM DipSIM course. As a consequence of these, it is not possible for the College to enter into an association with you, any of your organisations nor the DipSIM course at the present time. It would, therefore, be wrong to represent to others that any such association has been agreed.
You will appreciate that, in these circumstances, you will not receive an invitation to the meeting of 15th April 2010 nor to other planned events.
I am sorry to disappoint you in this matter.
I’ll confess to feeling almost a little guilty for having appeared to persecute the particular individuals involved in thie episode. But patients are involved and so is the law, and both of these are more important than individuals, The only unfair aspect is that, while it seems that even the Prince of Wales’ Foundation for Integrated Health has rejected Daniel and Atkinson, that Foundation embraces plenty of people who are just as deluded, and potentially dangerous, as those two. The answer to that problem is for the Prince to stop endorsing treatments that don’t work.
As for the University of Buckingham. Well, despite the ‘right wing maverick’ Kealey and the ‘anti-evidence’ Miles, I really think they’ve done the right thing. They’ve listened, they’ve maintained academic rigour and they’ve released all information for which I asked and a lot more. Good for them, I say.
15 April 2010. This story was reported by Times Higher Education, under the title “It’s terminal for integrated medicine diploma“. That report didn’t attract comments. But on 25th April Dr Rosy Daniel replied with “‘Terminal’? We’ve only just begun“. This time there were some feisty responses. Dr Daniel really should check her facts before getting into print.
3 March 2011. Unsurprisingly, Dr Daniel is up and running again, under the name of the British College of Integrated Medicine. The only change seems to be that Mark Atkinson has jumped ship altogether, and, of course, she is now unable to claim endorsement by Buckingham, or any other university. Sadly, though, Karol Sikora seems to have learned nothing from the saga related above. He is still there as chair of the Medical Advisory Board, along with the usual suspects mentioned above.
Snow on December 18th Roaring fire
Lindy contributes acute comments regularly here. She is also an accomplished musician. She has kindly allowed me to post here four of her re-written carols.
Adam lay ybounden | Hark the Herald | Holly and the Ivy | Merry Gentlemen
Adam lay ybounden
The Middle English dialect is not easy to follow. In fact Wikipedia reveals that it is oit even standard Middle English, but Macaronic English. The original words are reproduced in the right hand column. The original, sung by choir of King’s College Chapel, is on YouTube.
|Atoms lay y’bounden
In primordial soup;
Six billion years did pass
A’fore they could regroup.
For first had bin a big bang
The universe was shook;
Though through milennia
For god it was mistook.
Then particles of light did shine, ema-
-nating from the sun.
Out of soup arose archaea
And so life was begun.
Thanks be to the man
This mystery did solve;
Through him we celebrate how we
Did from the bugs evolve.
Adam lay ybounden,
Bounden in a bond:
Four thousand winter
Thought he not too long.
And all was for an apple,
An appil that he took,
As clerkè finden
Written in their book.
Ne had the apple taken been,
The appil taken been,
Ne had never our lady
Abeen heavenè queen.
Blessèd be the time
That appil taken was,
Therefore we moun singen,
Hark the Herald Angels sing.
This version is for Simon Singh. If you haven’t yet signed the new peition, please do it here.
Mark this very dang’rous thing,
Story is of Simon Singh.
He got chiropractors riled,
“Sod it! We have been defiled!
Ployful all ye woosters rise,
Join us to defend our lies,
With us loudly please proclaim,
Subluxations are our game”
Christ, they all with one accord
Took young Simon off to court.
“We’ll put you before a judge,
Since we always bear a grudge
‘Gainst all those who say our modus
Operandi is all bogus;
Mark the words of justice Eady,
Gave his ruling oh so speedy.
Mark the case of Simon Singh
With support the web does ring.
Ditch draconian libel laws,
Without which they’d have no cause
To sue those who would speak freely,
Truth, opinion-and reason really
Should prevail o’er all such things,
Surely he his case must win.
The Holly and the Ivy
Dedicated to the Prince of Wales, certain vice-chancellors and other champions of the endarkenment.
The folly and the lies, see
How they’ve become full-blown;
The braying of th’quackti’tioner Roy-
Al, th’enlightenment has flown.
Refrain: For deriding all the data
(Such stunning stuff we hear)!
The displaying of such cherry pick-
-Ing, beats bringing in Chi square.
The folly hears no critics
It makes you quite struck dumb,
Just put a poison substance in,
And dilute to kingdom come.
For deriding all the data etc.
The folly so does blossom,
Beguiles you with its charm,
Just make some movements with your wrist
And it will do no harm.
For deriding all the data etc.
The folly’s given credence
If you are qualified
With a BSc in pseudosci-
-Ence, th’endarkenment is nigh!
For deriding all the data etc.
The folly bears a burden
Now it has fallen down;
F.O.I requests and publicity
Have giv’n D.C. the crown.
For deriding all the data etc.
The folly is so fickle,
How did they have the gall
To tell us how their remedies
Were here to treat us all?
For deriding all the data etc.
The folly and the lies, see
How they must surely fail
We’ll drink a toast to good evidence
And let real science prevail!
Oh the rising of the Reiki,
Of acupuncture too,
All Rolfering* and Tuina-ish,
They all amount to woo.
*The names Rolf and Roger seem remarkably similar in some circumstances so I get a little confused.
Here is Lindy’s version of "god rest ye merry gentleman", composed in the wake of the admission by the Professional Standards director of Boots the Chemists that they sell homeopathic pills despite being aware of the fact that there is no reason to think they work.
I arrest you merry gentlemen,
Please kindly step this way.
For you are selling sugar pills
For which the people pay;
We’re from the Trading Standards and through courts we’ll find a way
To stop your profit-making ploy, Profiting ploy,
We’ll stop your profiteering ploy”!
The chemists calmly did defend
Themselves though they were riled;
“The people do demand these pills
Because they’re not defiled
With molecules (nor ‘owt at all), despite the claims so wild;
We’ll continue our profiteering ploy, Profiting ploy,
We’ll continue our profiteering ploy”.
So Trading Standards did respond
“We understand your aim
To make more money, though if you
Persist with bogus claim
To cure disease with sugar pills,
We’ll put you all to shame!
We are stopping your profiteering ploy, Profiting ploy,
We are stopping your profiteering ploy”.
“You breach the regulations by selling pills, you see,
Which claim to contain ‘aqua’ (dilute to 30C),
Or ‘dolphin song’ or ‘canine testes’ – even ‘ATP’!
So you’ll stop all this profiteering ploy, profiting ploy,
So you’ll stop all this profiteering ploy”.
The Dept of Health bangs on and on
About a patient’s choice,
But all good people must condemn
These lies with one great voice.
We dream of days when fibs are gone and we can all rejoice
‘Cos they’ve stopped all their profiteering ploy, Profiting ploy,
‘Cos they’ve stopped all their profiteering ploy
The Yuletide edition of the BMJ carries a lovely article by Jeffrey Aronson, Patent medicines and secret remedies. (BMJ 2009;339:b5415).
I was delighted to be asked to write an editorial about it, In fact it proved quite hard work, because the BMJ thought it improper to be too rude about the royal family, or about the possibility of Knight Starvation among senior medics. The compromise version that appeared in the BMJ is on line (full text link).
The changes were sufficient that it seems worth posting the original version (with links embedded for convenience).
The cuts are a bit ironic, since the whole point of the article is to point out the stifling political correctness that has gripped the BMA, the royal colleges, and the Department of Health when it comes to dealing with evidence-free medicine. It has become commonplace for people to worry about the future of the print media, The fact of the matter is you can often find a quicker. smarter amd blunter response to the news on blogs than you can find in the dead tree media. I doubt that the BMJ is in any danger of course. It has a good reputation for its attitude to improper drug company influence (a perpetual problem for clinical journals) as well as for clinical and science articles. It’s great to see its editor, Fiona Godlee, supporting the national campaign for reform of the libel laws (please sign it yourself).
The fact remains that when it comes to the particular problem of magic medicine, the action has not come from the BMA, the royal colleges, and certainly not from the Department of Health, It has come from what Goldacre called the “intrepid, ragged band of bloggers”. They are the ones who’ve done the investigative journalism, sent complaints and called baloney wherever they saw it. This article was meant to celebrate their collective efforts and to celebrate the fact that those efforts are beginning to percolate upwards to influence the powers that be.
It seems invidious to pick on one example, but if you want an example of beautiful and trenchant writing on one of the topics dealt with here, you’d be better off reading Andrew Lewis’s piece "Meddling Princes, Medical Regulation and Licenses to Kill” than anything in a print journal.
I was a bit disappointed by removal of the comment about the Prince of Wales. In fact I’m not particularly republican compared with many of my friends. The royal family is clearly good for the tourist industry and that’s important. Since Mrs Thatcher (and her successors) destroyed large swathes of manufacturing and put trust in the vapourware produced by dishonest and/or incompetent bankers, it isn’t obvious how the UK can stay afloat. If tourists will pay to see people driving in golden coaches, that’s fine. We need the money. What is absolutely NOT acceptable is for royals to interfere in the democratic political process. That is what the Prince of Wales does incessantly. No doubt he is well-meaning, but that is not sufficient. If I wanted to know the winner of the 2.30 at Newmarket, it might make sense to ask a royal. In medicine it makes no sense at all. But the quality of the advice is irrelevant anyway. The royal web site itself says “As a constitutional monarch, the Sovereign must remain politically neutral.”. Why does she not apply that rule to her son? Time to put him over your knee Ma’am?
Two of the major bits that were cut out are shown in bold, The many other changes are small.
BMJ editorial December 2009
Secret remedies: 100 years on
Time to look again at the efficacy of remedies
Jeffrey Aronson in his article  gives a fascinating insight into how the BMA, BMJ and politicians tried, a century ago, to put an end to the marketing of secret remedies. They didn’t have much success.
The problems had not improved 40 years later when A.J. Clark published his book on patent medicines . It is astounding to see how little has changed since then. He wrote, for example, “On the other hand the quack medicine vendor can pursue his advertising campaigns in the happy assurance that, whatever lies he tells, he need fear nothing from the interference of British law. The law does much to protect the quack medicine vendor because the laws of slander and libel are so severe.”> Clark himself was sued for libel after he’d written in a pamphlet “ ‘Cures’ for consumption, cancer and diabetes may fairly be classed as murderous”. Although he initially tried to fight the case, impending destitution eventually forced him to apologise . If that happened today, the accusation would have been repeated on hundreds of web sites round the world within 24 hours, and the quack would, with luck, lose .
As early as 1927, Clark had written “Today some travesty of physical science appears to be the most popular form of incantation” . That is even more true today. Homeopaths regularly talk utter nonsense about quantum theory  and ‘nutritional therapists’ claim to cure AIDS with vitamin pills or even with downloaded music files. Some of their writing is plain delusional, but much of it is a parody of scientific writing. The style, which Goldacre  calls ‘sciencey’, often looks quite plausible until you start to check the references.
A 100 years on from the BMA’s efforts, we need once again to look at the efficacy of remedies. Indeed the effort is already well under way, but this time it takes a rather different form. The initiative has come largely from an “intrepid, ragged band of bloggers” and some good journalists, helped by many scientific societies, but substantially hindered by the BMA, the Royal Colleges, the Department of Health and a few vice-chancellors. Even NICE and the MHRA have not helped much. The response of the royal colleges to the resurgence in magic medicine that started in the 1970s seems to have been a sort of embarrassment. They pushed the questions under the carpet by setting up committees (often populated with known sympathizers) so as to avoid having to say ‘baloney’. The Department of Health, equally embarrassed, tends to refer the questions to that well-known medical authority, the Prince of Wales (it is his Foundation for Integrated Health that was charged with drafting National Occupational Standards in make-believe subjects like naturopathy .
Two recent examples suffice to illustrate the problems.
The first example is the argument about the desirability of statutory regulation of acupuncture, herbal and traditional Chinese medicine (the Pittilo recommendations) .
Let’s start with a definition, taken from ‘A patients’ guide to magic medicine’ . “Herbal medicine: giving patients an unknown dose of an ill-defined drug, of unknown effectiveness and unknown safety”.
It seems to me to be self-evident that you cannot start to think about a sensible form of regulation unless you first decide whether what you are trying to regulate is nonsense, though this idea does not seem to have penetrated the thinking of the Department of Health or the authors of the Pittilo report. The consultation on statutory regulation has had many submissions  that point out the danger to patients of appearing to give official endorsement of treatments that don’t work. The good news is that there seems to have been a major change of heart at the Royal College of Physicians. Their submission points out with admirable clarity that the statutory regulation of things that don’t work is a danger to patients (though they still have a blank spot about the evidence for acupuncture, partly as a result of the recent uncharacteristically bad assessment of the evidence by NICE ). Things are looking up. Nevertheless, after the public consultation on the report ended on November 16th, the Prince of Wales abused his position to make a well-publicised intervention on behalf of herbalists . Sometimes I think his mother should give him a firm lesson in the meaning of the term ‘constitutional monarchy’, before he destroys it.
The other example concerns the recent ‘evidence check: homeopathy’ conducted by the House of Commons Science and Technology Select Committee (SCITECH). First the definition : “Homeopathy: giving patients medicines that contain no medicine whatsoever”. When homeopathy was dreamt up, at the end of the 18th century, regular physicians were lethal blood-letters, and it’s quite likely that giving nothing saved people from them. By the mid-19th century, discoveries about the real causes of disease had started, but homeopaths remain to this day stuck in their 18th century time warp.
In 1842 Oliver Wendell Holmes said all that needed to be said about medicine-free medicine . It is nothing short of surreal that the UK parliament is still discussing it in 2009. Nevertheless it is worth watching the SCITECH proceedings . The first two sessions are fun, if only for the statement by the Professional Standards Director of Boots that they sell homeopathic pills while being quite aware that they don’t work. I thought that was rather admirable honesty. Peter Fisher, clinical director of the Royal Homeopathic Hospital, went through his familiar cherry-picking of evidence, but at least repeated his condemnation of the sale of sugar pills for the prevention of malaria.
But for pure comedy gold, there is nothing to beat the final session. The health minister, Michael O’Brien, was eventually cajoled into admitting that there was no good evidence that homeopathy worked but defended the idea that the taxpayer should pay for it anyway. It was much harder to understand the position of the chief scientific advisor in the Department of Health, David Harper. He was evasive and ill-informed. Eventually the chairman, Phil Willis, said “No, that is not what I am asking you. You are the Department’s Chief Scientist. Can you give me one specific reference which supports the use of homeopathy in terms of Government policy on health?”. But answer came there none (well, there were words, but they made no sense).
Then at the end of the session Harper said “homeopathic practitioners would argue that the way randomised clinical trials are set up they do not lend themselves necessarily to the evaluation and demonstration of efficacy of homeopathic remedies, so to go down the track of having more randomised clinical trials, for the time being at least, does not seem to be a sensible way forward.” Earlier, Kent Woods (CEO of the MHRA) had said “the underlying theory does not really give rise to many testable hypotheses”. These two eminent people seemed to have been fooled by the limp excuses offered by homeopaths. The hypotheses are testable and homeopathy, because it involves pills, is particularly well suited to being tested by proper RCTs (they have been, and when done properly, they fail). If you want to know how to do it, all you have to do is read Goldacre in the Guardian .
It really isn’t vert complicated. “Imagine going to an NHS hospital for treatment and being sent away with nothing but a bottle of water and some vague promises.” “And no, it’s not a fruitcake fantasy. This is homeopathy and the NHS currently spends around £10million on it.”
That was written by health journalist Jane Symons, in The Sun . A Murdoch tabloid has produced a better account of homeopathy than anything that could be managed by the chief scientific advisor to the Department of Health. And it isn’t often that one can say that.
These examples serve to show that the medical establishment is slowly being dragged, from the bottom up, into realising that matters of truth and falsehood are more important than their knighthoods. It is all very heartening, both for medicine and for democracy itself.
Declaration of interests. I was A.J. Clark chair of pharmacology at UCL, 1985 – 2004.
1. Aronson, JK BMJ 2009;339:b5415
2. Clark, A,J, (1938) Patent Medicines FACT series 14, London. See also Patent medicines in 1938 and now http://www.dcscience.net/?p=257
3. David Clark “Alfred Joseph Clark, A Memoir” (C. & J. Clark Ltd 1985 ISBN 0-9510401-0-3)
4. Lewis, A. (2007) The Gentle Art of Homeopathic Killing
5. A.J. Clark (1927) The historical aspect of quackery, BMJ October 1st 1927
6. Chrastina, D (2007) Quantum theory isn’t that weak, (response to Lionel Milgrom).
7 Goldacre, B. (2008) Bad Science. HarperCollins
8. Skills for Health web site
9. A very bad report: gamma minus for the vice-chancellor
10. A Patients’ Guide to Magic Medicine, and also in the Financial Times.
11. An excellent submission to the consultation on statutory regulation of alternative medicine (Pittilo report)
12. NICE fiasco, part 2. Rawlins should withdraw guidance and start again
13. BBC news 1 December 2009 Prince Charles: ‘Herbal medicine must be regulated’.
14. Oliver Wendell Holmes (1842) Homeopathy and Its Kindred Delusions.
15. House of Commons Science and technology committee. Evidence check: homeopathy. Videos and transcripts available at http://www.viewista.com/s/fywlp2/ez/1
16. Goldacre, B. A Kind of Magic Guardian 16 November 2007.
17. Homeopathy is resources drain says
There is a good account of the third SCITECH session by clinical science consultant, Majikthyse, at The Three Amigos.
16 December 2009.. Recorded an interview for BBC Radio 5 Live. It was supposed to go out early on 17th.
17 December 2009. The editorial is mentioned in Editor’s Choice, by deputy editor Tony Delamothe. I love his way of putting the problem "too many at the top of British medicine seem frozen in the headlights of the complementary medicine bandwagon". He sounds remarkably kind given that I was awarded (by the editor, Fiona Godlee, no less) a sort of booby prize at the BMJ party for having generated a record number of emails during the editing of a single editorial (was it really 24?). Hey ho.
17 December 2009. More information on very direct political meddling by the Prince of Wales in today’s Guardian, and in Press Association report.
17 December 2009. Daily Telegraph reports on the editorial, under the heading “ ‘Nonsense’ alternative medicines should not be regulated“. Not a bad account for a non-health journalist.
17 December 2009. Good coverage in the excellent US blog, Neurologica, by the superb Steven Novella.’ “Intrepid, Ragged Band of Bloggers” take on CAM‘ provides a chance to compare and contrast the problems in the UK and the USA.’
18 December 2009. Article in The Times by former special advisor, Paul Richards. “The influence of Prince Charles the lobbyist is out of hand. Our deference stops us asking questions.”
“A good starting point might be publication of all correspondence over the past 30 years. Then we will know the extent, and influence, of Prince Charles the lobbyist.”
Comments in the BMJ Quite a lot of comments had appeared by January 8th, though sadly they were mostly from the usual suspects who appear every time one suggests evidence matters. A reply was called for, so I sent this (the version below has links).
After a long delay, this response eventually appeared in the BMJ on January 15 2010.
It’s good to see so many responses, though somewhat alarming to see that several of them seem to expect an editorial to provide a complete review of the literature. I ‘ll be happy to provide references for any assertion that I made.
I also find it a bit odd that some people think that an editorial is not the place to express an opinion robustly. That view seems to me to be a manifestation of the very sort of political correctness that I was deploring. It’s a bit like the case when the then health minister, Lord Hunt, referred to psychic surgery as a “profession” when he should have called it a fraudulent conjuring trick. Anything I write is very mild compared with what Thomas Wakley wrote in the Lancet, a journal which he founded around the time UCL came into existence. For example (I quote)
“[We deplore the] “state of society which allows various sets of mercenary, goose-brained monopolists and charlatans to usurp the highest privileges…. This is the canker-worm which eats into the heart of the medical body.” Wakley, T. The Lancet 1838-9, 1
I don’t think it is worth replying to people who cite Jacques Benveniste or Andrew Wakefield as authorities. Neither is it worth replying to people who raise the straw man argument about wicked pharmaceutical companies (about which I am on record as being as angry as anyone). But I would like to reply directly to some of the more coherent comments.
Sam Lewis and Robert Watson. [comment] Thank you for putting so succinctly what I was trying to say.
Peter Fisher [comment]. I have a lot of sympathy for Peter Fisher. He has attempted to do some good trials of homeopathy (they mostly had negative outcomes). He said he was "very angry" when the non-medical homeopaths were caught out recommending their sugar pills for malaria prevention (not that this as stopped such dangerous claims which are still commonplace). He agreed with me that there was not sufficient scientific basis for BSc degrees in homeopathy. I suppose that it isn’t really surprising that he continues to cherry pick the evidence. As clinical director of the Royal London Homeopathic Hospital and Homeopathic physician to the Queen, just imagine the cognitive dissonance that would result if he were to admit publicly that is all placebo after all. He has come close though. His (negative) trial for homeopathic treatment of rheumatoid arthritis included the words "It seems more important to define if homeopathists can genuinely control patients’ symptoms and less relevant to have concerns about whether this is due to a ‘genuine’ effect or to influencing the placebo response” . [download
the paper]. When it comes to malaria, it matters a lot.
Adrian White [comment] seems to be cross because I cited my own blog. I did that simply because if he follows the links there he will find the evidence. In the case of acupuncture it has been shown time after time that "real" acupuncture does not differ perceptibly from sham. That is true whether the sham consists of retractable needles or real needles in the "wrong" places. A non-blind comparison between acupuncture and no acupuncture usually shows some advantage for the former but it is, on average, too small to be of much clinical significance . I agree that there is no way to be sure that this advantage is purely placebo effect but since it is small and transient it really doesn’t matter much. Nobody has put it more clearly than Barker Bausell in his book, Snake Oil Science 
White also seems to have great faith in peer review. I agree that in real science it is probably the best system we have. But in alternative medicine journals the "peers" are usually other true believers in whatever hocus pocus is being promoted and peer reveiw breaks down altogether.
R. M. Pittilo [comment] I’m glad that Professor Pittilo has replied in person because I did single out his report for particular criticism. I agree that his report said that NHS funding should be available to CAM only where there is evidence of efficacy. That was not my criticism. My point was that in his report, the evidence for efficacy was assessed by representatives of Herbal Medicine, Chinese Medicine and Acupuncture (four from each). Every one of them would have been out of work if they had found their subjects were nonsense and that, no doubt, explains why the assessment was so bad. To be fair, they did admit that the evidence was not all that it might be and recommended (as always) more research I’d like to ask Professor Pittilo how much money should be spent on more research in the light of the fact that over a billion dollars has been spent in the USA on CAM research without producing a single useful treatment. Pittilo says "My own view is that both statutory regulation and the quest for evidence should proceed together" but he seems to neglect the possibility that the quest for evidence might fail. Experience in the USA suggests that is exactly what has, to a large extent, already happened.
I also find it quite absurd that the Pittilo report should recommend, despite a half-hearted admission that the evidence is poor, that entry to these subjects should be via BSc Honours degrees. In any case he is already thwarted in that ambition because universities are closing down degrees in these subjects having realised that the time to run a degree is after, not before, you have some evidence that the subject is not nonsense. I hope that in due course Professor Pittilo may take the same action about the courses in things like homeopathy that are run by the university of which he is vice-chancellor. That could only enhance the academic reputation of Robert Gordon’s University.
George Lewith [comment] You must be aware that the proposed regulatory body, the Health Professions Council, has already broken its own rules about "evidence-based practice" by agreeing to take on, if asked, practitioners of Herbal Medicine, Chinese Medicine and Acupuncture. They have (shamefully) excluded the idea that claims of efficacy would be regulated. In other word they propose to provide exactly the sort of pseudo-regulation which would endanger patients They are accustomed to the idea that regulation is to do only with censoring practitioners who are caught in bed with patients. However meritorious that may be, it is not the main problem with pseudo-medicine, an area in which they have no experience. I’m equally surprised that Lewith should recommend that Chinese evaluation of Traditional Chinese medicine should be included in meta-analyses, in view of the well-known fact that 99% of evaluations from China are positive: “No trial published in China or Russia/USSR found a test treatment to be ineffective” . He must surely realise that medicine in China is a branch of politics. In fact the whole resurgence in Chinese medicine and acupuncture in post-war times has less to do with ancient traditions than with Chinese nationalism, in particular the wish of Mao Tse-Tung to provide the appearance of health care for the masses (though it is reported that he himself preferred Western Medicine).
1. Lord Hunt thinks “psychic surgery” is a “profession”. http://www.dcscience.net/?p=258
2. Fisher, P. Scott, DL. 2001 Rheumatology 40, 1052 – 1055. [pdf file]
3. Madsen et al, BMJ 2009;338:a3115 [pdf file]
4. R, Barker Bausell, Snake Oil Science, Oxford University Press, 2007
5. Vickers, Niraj, Goyal, Harland and Rees (1998, Controlled Clinical Trials, 19, 159-166) “Do Certain Countries Produce Only Positive Results? A Systematic Review of Controlled Trials”. [pdf file]
15 January 2010. During the SciTech hearings, Kent Woods (CEO of the MHRA) made a very feeble attempt to defend the MHRA’s decision to allow misleading labelling of homeopathic products. Now they have published their justification for this claim. It is truly pathetic, as explained by Martin at LayScience: New Evidence Reveals the MHRA’s Farcical Approach to Homeopathy. This mis-labelling cause a great outcry in 2006, as documented in The MHRA breaks its founding principle: it is an intellectual disgrace, and Learned Societies speak out against CAM, and the MHRA.
22 January 2010 Very glad to see that the minister himself has chosen to respond in the BMJ to the editorial
Rt Hon. Mike O’Brien QC MP, Minister of State for Health Services
I am glad that David Colquhoun was entertained by my appearance before the Health Select Committee on Homeopathy. But he is mistaken when he says, “you cannot start to think about a sensible form of regulation unless you first decide whether or not the thing you are trying to regulate is nonsense.”
Regulation is about patient safety. Acupuncture, herbal and traditional Chinese medicine involve piercing the skin and/or the ingestion of potentially harmful substances and present a possible risk to patients.
The Pittilo Report recommends statutory regulation and we have recently held a public consultation on whether this is a sensible way forward.
Further research into the efficacy of therapies such as Homeopathy is unlikely to settle the debate, such is the controversy surrounding the subject. That is why the Department of Health’s policy towards complementary and alternative medicines is neutral.
Whether I personally think Homeopathy is nonsense or not is besides the point. As a Minister, I do not decide the correct treatment for patients. Doctors do that. I do not propose on this occasion to interfere in the doctor-patient relationship.
Here is my response to the minister
I am very glad that the minister himself has replied. I think he is wrong in two ways, one relatively trivial but one very important.
First, he is wrong to refer to homeopathy as controversial. It is not. It is quite the daftest for the common forms of magic medicine and essentially no informed person believes a word of it. Of course, as minister, he is free to ignore scientific advice, just as the Home Secretary did recently. But he should admit that that is what he is doing, and not hide behind the (imagined) controversy.
Second, and far more importantly, he is wrong, dangerously wrong, to say it I was mistaken to claim that “you cannot start to think about a sensible form of regulation unless you first decide whether or not the thing you are trying to regulate is nonsense". According to that view it would make sense to grant statutory regulation to voodoo and astrology. The Pittilo proposals would involve giving honours degrees in nonsense if one took the minister’s view that it doesn’t matter whether the subjects are nonsense or not. Surely he isn’t advocating that?
The minister is also wrong to suppose that regulation, in the form proposed by Pittilo, would do anything to help patient safety. Indeed there is a good case to be made that it would endanger patients (not to mention endangering tigers and bears). The reason for that is that the main danger to patients arises from patients being given “remedies” that don’t work. The proposed regulatory body, the Health Professions Council, has already declared that it is not interested in whether the treatments work or not. That in itself endangers patients. In the case of Traditional Chinese Medicine, there is also a danger to patients from contaminated medicines. The HPC is not competent to deal with that either. It is the job of the MHRA and/or Trading Standards. There are much better methods of ensuring patient safety that those proposed by Pittilo.
In order to see the harm that can result from statutory regulation, it is necessary only to look at the General Chiropractic Council. Attention was focussed on chiropractic when the British Chiropractic Association decided, foolishly, to sue Simon Singh for defamation. That led to close inspection of the strength of the evidence for their claims to benefit conditions like infant colic and asthma. The evidence turned out to be pathetic, and the result was that something like 600 complaints were made to the GCC about the making of false health claims (including two against practices run by the chair of the GCC himself). The processing of these complaints is still in progress, but what is absolutely clear is that the statutory regulatory body, the GCC, had done nothing to discourage these false claims. On the contrary it had perpetrated them itself. No doubt the HPC would be similarly engulfed in complaints if the Pittilo proposals went ahead.
It is one thing to say that the government chooses to pay for things like homeopathy, despite it being known that they are only placebos, because some patients like them. It is quite another thing to endanger patient safety by advocating government endorsement in the form of statutory regulation, of treatments that don’t work.
I would be very happy to meet the minister to discuss the problems involved in ensuring patient safety. He has seen herbalists and other with vested interests. He has been lobbied by the Prince of Wales. Perhaps it is time he listened to the views of scientists too.
Both the minister’s response, and my reply, were reformatted to appear as letters in the print edition of the BMJ, as well as comments on the web..